Provider Demographics
NPI:1649970419
Name:ONWUSOR, CHIDI SAMUEL (AGACNP)
Entity type:Individual
Prefix:
First Name:CHIDI
Middle Name:SAMUEL
Last Name:ONWUSOR
Suffix:
Gender:M
Credentials:AGACNP
Other - Prefix:
Other - First Name:CHIDI
Other - Middle Name:SAMAULE
Other - Last Name:ONWUSOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AGACNP
Mailing Address - Street 1:1620 PEGASUS DR
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-1337
Mailing Address - Country:US
Mailing Address - Phone:214-516-0197
Mailing Address - Fax:
Practice Address - Street 1:3500 W WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3460
Practice Address - Country:US
Practice Address - Phone:214-947-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1098898363LA2100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine