Provider Demographics
NPI:1801248745
Name:ONYEGBUNWA, LILLIAN BOSE (FNP)
Entity type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:BOSE
Last Name:ONYEGBUNWA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:321 PALO DURO DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75069-1286
Mailing Address - Country:US
Mailing Address - Phone:214-434-3528
Mailing Address - Fax:
Practice Address - Street 1:18110 MIDWAY RD STE 136
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-6632
Practice Address - Country:US
Practice Address - Phone:214-613-6009
Practice Address - Fax:214-613-6002
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-04
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130847363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily