Provider Demographics
NPI:1710536388
Name:OLUNKWA, CHIOMA JENNIFER
Entity Type:Individual
Prefix:
First Name:CHIOMA
Middle Name:JENNIFER
Last Name:OLUNKWA
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 1:2203 LEWIS TRL
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-2273
Mailing Address - Country:US
Mailing Address - Phone:214-875-0818
Mailing Address - Fax:
Practice Address - Street 1:METHODIST CHARLTON MEDICAL CENTER
Practice Address - Street 2:3500 W WHEATLAND RD
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237
Practice Address - Country:US
Practice Address - Phone:214-947-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care