Provider Demographics
NPI:1063916773
Name:ONYANCHA, ROSE (RN)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:ONYANCHA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 JORGENSON RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-1968
Mailing Address - Country:US
Mailing Address - Phone:214-753-6578
Mailing Address - Fax:
Practice Address - Street 1:1001 JORGENSON RD
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-1968
Practice Address - Country:US
Practice Address - Phone:214-753-6578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX770603163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse