Provider Demographics
NPI:1568224210
Name:ODUNUKWE, ELISA NICOLE (FNP)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:NICOLE
Last Name:ODUNUKWE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5226 BAKER BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-0001
Mailing Address - Country:US
Mailing Address - Phone:479-719-5292
Mailing Address - Fax:
Practice Address - Street 1:5226 BAKER BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-0001
Practice Address - Country:US
Practice Address - Phone:479-719-5292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR226439363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty