MEDICARE: ANDY ONONIWU

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	164W00000X	Licensed Practical Nurse	193560	TX

General Provider Information

NPI Number	:	1891313540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDY ONONIWU

Provider Business Mailing Address
First Line	:	1228 SULLIVAN DR
Second Line	:
City	:	CEDAR HILL
State	:	TX
Zip	:	75104-7340
Country	:	US
Telephone Number	:	682-365-5693
Fax Number	:

Provider Business Practice Location Address
First Line	:	1228 SULLIVAN DR
Second Line	:
City	:	CEDAR HILL
State	:	TX
Zip	:	75104-7340
Country	:	US
Telephone Number	:	682-365-5693
Fax Number	:

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

Provider Enumeration Date	:	07/09/2020
Last Update Date	:	07/09/2020

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Directions to “ ANDY ONONIWU ” Practice Location

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