MEDICARE: SUNRISE PRIMARY CARE & WELLNESS CENTER LLC

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1588473094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE PRIMARY CARE & WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	4407 TALL MEADOW CT
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76001-6667
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 E BARDIN RD STE 108
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76018-1030
Country	:	US
Telephone Number	:	214-235-4367
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EMMANUEL OKOLO
Credential	:
Telephone Number	:	214-235-4367

Provider Enumeration Date	:	12/31/2024
Last Update Date	:	06/30/2025

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