MEDICARE: MRS. TERESA MOIGE ONSONGO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	954860	TX

General Provider Information

NPI Number	:	1164997409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERESA MOIGE ONSONGO

Provider Business Mailing Address
First Line	:	6715 BARRED OWL RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-3673
Country	:	US
Telephone Number	:	682-559-8028
Fax Number	:

Provider Business Practice Location Address
First Line	:	6715 BARRED OWL RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-3673
Country	:	US
Telephone Number	:	682-559-8028
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2018
Last Update Date	:	10/12/2018

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