Provider Demographics
NPI:1811373673
Name:ONUNGWA, ODOCHI
Entity type:Individual
Prefix:
First Name:ODOCHI
Middle Name:
Last Name:ONUNGWA
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 1:1675 REPUBLIC PKWY
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6903
Mailing Address - Country:US
Mailing Address - Phone:214-957-3358
Mailing Address - Fax:972-803-5317
Practice Address - Street 1:1675 REPUBLIC PKWY
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6903
Practice Address - Country:US
Practice Address - Phone:214-957-3358
Practice Address - Fax:972-803-5317
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128636363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily