Provider Demographics
NPI:1023567401
Name:EGBONIM, MARGARET O (FNP-C)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:O
Last Name:EGBONIM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 GREATVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1245
Mailing Address - Country:US
Mailing Address - Phone:803-460-2115
Mailing Address - Fax:
Practice Address - Street 1:4309 GREATVIEW DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1245
Practice Address - Country:US
Practice Address - Phone:803-460-2115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131879363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care