Provider Demographics
NPI:1265975718
Name:AGUWA, IHECHI M
Entity type:Individual
Prefix:
First Name:IHECHI
Middle Name:M
Last Name:AGUWA
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 1:12392 HAWK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-5294
Mailing Address - Country:US
Mailing Address - Phone:513-593-1856
Mailing Address - Fax:
Practice Address - Street 1:12392 HAWK CREEK DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-5294
Practice Address - Country:US
Practice Address - Phone:513-593-1856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132590363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily