Provider Demographics
NPI:1740506724
Name:ENYINNA-OKEIGBO, CHARLES UDO (RN)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:UDO
Last Name:ENYINNA-OKEIGBO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:UDO
Other - Middle Name:CHARLES
Other - Last Name:ENYINNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9304 FOREST LN
Mailing Address - Street 2:STE 216 S
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-6238
Mailing Address - Country:US
Mailing Address - Phone:214-295-4324
Mailing Address - Fax:
Practice Address - Street 1:9304 FOREST LN
Practice Address - Street 2:STE 216 S
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-6238
Practice Address - Country:US
Practice Address - Phone:214-295-4324
Practice Address - Fax:214-295-4397
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX716453163W00000X, 163WH0200X, 3747P1801X
TX716543163WC1500X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide