Provider Demographics
NPI:1891313540
Name:ONONIWU, ANDY
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:ONONIWU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 SULLIVAN DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-7340
Mailing Address - Country:US
Mailing Address - Phone:682-365-5693
Mailing Address - Fax:
Practice Address - Street 1:1228 SULLIVAN DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-7340
Practice Address - Country:US
Practice Address - Phone:682-365-5693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193560164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse