Provider Demographics
NPI:1013340520
Name:ONYIA, MODESTA OBIAGELI (FNP)
Entity Type:Individual
Prefix:
First Name:MODESTA
Middle Name:OBIAGELI
Last Name:ONYIA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 MESA CT
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-8289
Mailing Address - Country:US
Mailing Address - Phone:214-629-9639
Mailing Address - Fax:972-278-4606
Practice Address - Street 1:205 E UNIVERSITY AVE
Practice Address - Street 2:SUITE 157
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-6814
Practice Address - Country:US
Practice Address - Phone:512-868-9078
Practice Address - Fax:512-819-0646
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX679518363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily