Provider Demographics
NPI:1639843097
Name:IJEH, OMOKHUWA MARTHA ETSEOGHENA
Entity Type:Individual
Prefix:MRS
First Name:OMOKHUWA
Middle Name:MARTHA ETSEOGHENA
Last Name:IJEH
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 1:920 SNYDER DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072-3402
Mailing Address - Country:US
Mailing Address - Phone:862-279-8242
Mailing Address - Fax:
Practice Address - Street 1:5680 FRISCO SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-3300
Practice Address - Country:US
Practice Address - Phone:469-535-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1049261363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health