Provider Demographics
NPI:1407725146
Name:OSEMWONTA, SANDRA OGHOMWEN (DNP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:OGHOMWEN
Last Name:OSEMWONTA
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 HILLRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1186
Mailing Address - Country:US
Mailing Address - Phone:347-322-4907
Mailing Address - Fax:
Practice Address - Street 1:1313 HILLRIDGE DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1186
Practice Address - Country:US
Practice Address - Phone:347-322-4907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-31
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2025047720363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health