Individual
ESONGNYUO FOMUKONG-ETTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3050 REGENT BLVD STE 100, IRVING, TX 75063-3107
(214) 689-8076
Mailing address
PO BOX 9755, HOUSTON, TX 77213-0755
(832) 717-2780
(832) 717-2781
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP131427
TX
Other
Enumeration date
08/23/2016
Last updated
03/10/2020
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