Provider Demographics
NPI:1417521642
Name:EHIOGU, GLORY (FNP)
Entity Type:Individual
Prefix:
First Name:GLORY
Middle Name:
Last Name:EHIOGU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:GLORY
Other - Middle Name:
Other - Last Name:NWAOZURU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7331 GASTON AVE # 180
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-4131
Mailing Address - Country:US
Mailing Address - Phone:469-867-1550
Mailing Address - Fax:
Practice Address - Street 1:7331 GASTON AVE # 180
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-4131
Practice Address - Country:US
Practice Address - Phone:281-824-1854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1016314363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily