Provider Demographics
NPI:1144693789
Name:NWAOGBE, JOHNNY
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:
Last Name:NWAOGBE
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 1:844 KINWEST PKWY
Mailing Address - Street 2:225
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7408
Mailing Address - Country:US
Mailing Address - Phone:214-900-2325
Mailing Address - Fax:
Practice Address - Street 1:3362 FOREST LN
Practice Address - Street 2:304
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7796
Practice Address - Country:US
Practice Address - Phone:214-900-2325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide