Provider Demographics
NPI:1700252434
Name:TAWOSE, CHIOMA OHIRI (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:CHIOMA
Middle Name:OHIRI
Last Name:TAWOSE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:CHIOMA
Other - Middle Name:VICTORIA
Other - Last Name:OHIRI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:208 LE BLANC ST
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28307-2120
Mailing Address - Country:US
Mailing Address - Phone:214-683-1244
Mailing Address - Fax:
Practice Address - Street 1:110 MEDICAL HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340
Practice Address - Country:US
Practice Address - Phone:936-291-3219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128792363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX371149102Medicaid
TXAP128792OtherAPRN LICENSE