Provider Demographics
NPI:1093375412
Name:ONUOHA, AUGUSTINE
Entity Type:Individual
Prefix:
First Name:AUGUSTINE
Middle Name:
Last Name:ONUOHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 BRIDGEPORT DR
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409
Mailing Address - Country:US
Mailing Address - Phone:612-913-2560
Mailing Address - Fax:
Practice Address - Street 1:1313 BRIDGEPORT DR
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:TX
Practice Address - Zip Code:75409
Practice Address - Country:US
Practice Address - Phone:612-913-2560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX912224163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse