Provider Demographics
NPI:1104649631
Name:ONWUSOR, CHINWENDU PEACE
Entity type:Individual
Prefix:MRS
First Name:CHINWENDU
Middle Name:PEACE
Last Name:ONWUSOR
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 1:1620 PEGASUS DR
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-1337
Mailing Address - Country:US
Mailing Address - Phone:469-269-9972
Mailing Address - Fax:
Practice Address - Street 1:1620 PEGASUS DR
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-1337
Practice Address - Country:US
Practice Address - Phone:469-269-9972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2024084929363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty