Basic Information
Provider Information
NPI: 1003150681
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AWAGU
FirstName: NNENNA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: OKORFOR
OtherFirstName: NNENNA
OtherMiddleName: NKWO
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 7703 FLOYD CURL DR
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782293901
CountryCode: US
TelephoneNumber: 2105674500
FaxNumber:  
Practice Location
Address1: 4502 MEDICAL DR
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782294402
CountryCode: US
TelephoneNumber: 2105674500
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/20/2012
LastUpdateDate: 02/03/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X758857TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

ID Information
IDTypeStateIssuerDescription
31409230705TX MEDICAID


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