Provider Demographics
NPI:1811544000
Name:NWOKORO, NONYE
Entity type:Individual
Prefix:
First Name:NONYE
Middle Name:
Last Name:NWOKORO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 HIGHWAY 287 N STE 407
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3867
Mailing Address - Country:US
Mailing Address - Phone:214-210-5592
Mailing Address - Fax:505-212-1939
Practice Address - Street 1:733 HIGHWAY 287 N STE 407
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3867
Practice Address - Country:US
Practice Address - Phone:214-210-5592
Practice Address - Fax:505-212-1939
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-22
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61471066363LP0808X
NM63027363LP0808X
TXAP142730363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health