Provider Demographics
NPI:1477161164
Name:EGHIANRUWA, PRINCESS DASHAE (PMHNP)
Entity Type:Individual
Prefix:
First Name:PRINCESS
Middle Name:DASHAE
Last Name:EGHIANRUWA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 SALEM DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3352
Mailing Address - Country:US
Mailing Address - Phone:972-750-1617
Mailing Address - Fax:
Practice Address - Street 1:4225 WOODS PL
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-7991
Practice Address - Country:US
Practice Address - Phone:325-691-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-19
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1004003363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty