Provider Demographics
NPI:1669415279
Name:AWA, CHINYERE NNENNA (MD)
Entity type:Individual
Prefix:DR
First Name:CHINYERE
Middle Name:NNENNA
Last Name:AWA
Suffix:
Gender:F
Credentials:MD
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 572506
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77257-2506
Mailing Address - Country:US
Mailing Address - Phone:713-541-4442
Mailing Address - Fax:713-541-4567
Practice Address - Street 1:6300 WESTPARK DR STE 212
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-7207
Practice Address - Country:US
Practice Address - Phone:713-541-4442
Practice Address - Fax:713-541-4567
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7651207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163348901Medicaid
TX8B3447Medicare PIN
TXP00193854Medicare PIN
TX8F1757Medicare PIN
TX163348901Medicaid