Provider Demographics
NPI:1992388508
Name:ERONWU, INNOCENTIA ADAURE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:INNOCENTIA
Middle Name:ADAURE
Last Name:ERONWU
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1347 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-6234
Mailing Address - Country:US
Mailing Address - Phone:469-766-3749
Mailing Address - Fax:
Practice Address - Street 1:1347 RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-6234
Practice Address - Country:US
Practice Address - Phone:469-766-3749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-01
Last Update Date:2021-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1036250363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health