Provider Demographics
NPI:1023871761
Name:IGWEBUIKE, ALLOYSIUS
Entity type:Individual
Prefix:
First Name:ALLOYSIUS
Middle Name:
Last Name:IGWEBUIKE
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:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76097-0112
Mailing Address - Country:US
Mailing Address - Phone:214-714-0544
Mailing Address - Fax:
Practice Address - Street 1:1320 NW SUMMERCREST BLVD APT 212
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-9434
Practice Address - Country:US
Practice Address - Phone:121-471-4054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX231856164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse