Individual
IFESONYE EMILOJU OKWUCHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4430 MISSOURI AVE, FORT LEONARD WOOD, MO 65473-9098
(573) 596-0417
Mailing address
3123 FONTANA BLVD, ROCKWALL, TX 75032-4400
(806) 283-0352
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP129463
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
356946901
—
TX
Enumeration date
12/28/2015
Last updated
07/14/2020
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