Provider Demographics
NPI:1891260550
Name:NWAOKOLO, WINIFRED ETSEBOME
Entity Type:Individual
Prefix:
First Name:WINIFRED
Middle Name:ETSEBOME
Last Name:NWAOKOLO
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 1:1715 AUDREY DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-5531
Mailing Address - Country:US
Mailing Address - Phone:469-569-1077
Mailing Address - Fax:
Practice Address - Street 1:1715 AUDREY DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-5531
Practice Address - Country:US
Practice Address - Phone:469-569-1077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX303436164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse