Provider Demographics
NPI:1609282391
Name:ONIME, MILDRED (ANP)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:
Last Name:ONIME
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 W UNIVERSITY BLVD
Mailing Address - Street 2:APT: 10306
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-3876
Mailing Address - Country:US
Mailing Address - Phone:817-729-5793
Mailing Address - Fax:
Practice Address - Street 1:4400 W UNIVERSITY BLVD
Practice Address - Street 2:APT: 10306
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-3876
Practice Address - Country:US
Practice Address - Phone:817-729-5793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125351363LG0600X
TX767459364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology