Provider Demographics
NPI:1871191320
Name:ORIWO, THERESA EKUIRELE (FNP-C)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:EKUIRELE
Last Name:ORIWO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3019 HIDEAWAY DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-0432
Mailing Address - Country:US
Mailing Address - Phone:972-890-6688
Mailing Address - Fax:
Practice Address - Street 1:128 W BELT LINE RD STE 1
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2095
Practice Address - Country:US
Practice Address - Phone:469-482-9646
Practice Address - Fax:888-638-2902
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1016639363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty