Provider Demographics
NPI:1629621271
Name:ONYEKWERE, JUSTINA C
Entity Type:Individual
Prefix:
First Name:JUSTINA
Middle Name:C
Last Name:ONYEKWERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2635 STONELAKE DR APT 333
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-8799
Mailing Address - Country:US
Mailing Address - Phone:469-831-8324
Mailing Address - Fax:
Practice Address - Street 1:2635 STONELAKE DR APT 333
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-8799
Practice Address - Country:US
Practice Address - Phone:469-831-8324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX959866163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse