Provider Demographics
NPI:1619554516
Name:NWABUGWU, OGOCHUKWU CHINWE (NP)
Entity Type:Individual
Prefix:
First Name:OGOCHUKWU
Middle Name:CHINWE
Last Name:NWABUGWU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 BARDIN RD APT 1104
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-4287
Mailing Address - Country:US
Mailing Address - Phone:225-610-6361
Mailing Address - Fax:
Practice Address - Street 1:2770 BARDIN RD APT 1104
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-4287
Practice Address - Country:US
Practice Address - Phone:225-610-6361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAG12200097363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health