Provider Demographics
NPI:1215543079
Name:OGBOGU-NWANKWO, SYLVIA (NP)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:OGBOGU-NWANKWO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:974 SHADDOCK PARK LN
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5665
Mailing Address - Country:US
Mailing Address - Phone:469-682-5307
Mailing Address - Fax:
Practice Address - Street 1:974 SHADDOCK PARK LN
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5665
Practice Address - Country:US
Practice Address - Phone:469-682-5307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1013547363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty