Provider Demographics
NPI:1114417763
Name:IWUALA, GENEVIEVE (FNP)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:
Last Name:IWUALA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 BURTONWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:OVILLA
Mailing Address - State:TX
Mailing Address - Zip Code:75154-1495
Mailing Address - Country:US
Mailing Address - Phone:214-663-3614
Mailing Address - Fax:
Practice Address - Street 1:407 BURTONWOOD CIR
Practice Address - Street 2:
Practice Address - City:OVILLA
Practice Address - State:TX
Practice Address - Zip Code:75154-1495
Practice Address - Country:US
Practice Address - Phone:214-663-3614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136858363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily