Provider Demographics
NPI:1801242300
Name:DUKU, OGHENEYEROVWO FAVOUR (NP)
Entity type:Individual
Prefix:
First Name:OGHENEYEROVWO
Middle Name:FAVOUR
Last Name:DUKU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 CAMINO LA COSTA
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-3930
Mailing Address - Country:US
Mailing Address - Phone:512-478-4939
Mailing Address - Fax:
Practice Address - Street 1:1101 CAMINO LA COSTA
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-3930
Practice Address - Country:US
Practice Address - Phone:512-478-4939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202326948363LP0200X
TX1144243363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics