Provider Demographics
NPI:1477717163
Name:NWAGBARA, OKEY
Entity Type:Individual
Prefix:
First Name:OKEY
Middle Name:
Last Name:NWAGBARA
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 1:4506 VAUGHAN DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-7503
Mailing Address - Country:US
Mailing Address - Phone:972-475-3358
Mailing Address - Fax:972-475-3385
Practice Address - Street 1:4506 VAUGHAN DR
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-7503
Practice Address - Country:US
Practice Address - Phone:972-475-3358
Practice Address - Fax:972-475-3385
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide