Provider Demographics
NPI:1336623446
Name:AHANONU, GIDEON IBE (FNP)
Entity Type:Individual
Prefix:
First Name:GIDEON
Middle Name:IBE
Last Name:AHANONU
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 S SHILOH RD STE 218
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-8903
Mailing Address - Country:US
Mailing Address - Phone:972-808-7541
Mailing Address - Fax:972-808-7543
Practice Address - Street 1:1919 S SHILOH RD STE 218
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-8903
Practice Address - Country:US
Practice Address - Phone:972-808-7541
Practice Address - Fax:972-808-7543
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily