MEDICARE: MAVIS NWOKORIE

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	9522025	CA

General Provider Information

NPI Number	:	1992328751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAVIS NWOKORIE

Provider Business Mailing Address
First Line	:	3544 FAWN VALLEY DR APT 1024
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75224-5256
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3544 FAWN VALLEY DR APT 1024
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75224-5256
Country	:	US
Telephone Number	:	214-524-9410
Fax Number	:

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

Provider Enumeration Date	:	05/27/2020
Last Update Date	:	05/27/2020

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Directions to “ MAVIS NWOKORIE ” Practice Location

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