Provider Demographics
NPI:1194342857
Name:NWANKWO, OBINNA MARTIN (CRNA)
Entity type:Individual
Prefix:
First Name:OBINNA
Middle Name:MARTIN
Last Name:NWANKWO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6316 LOS BANCOS DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1857
Mailing Address - Country:US
Mailing Address - Phone:713-884-9579
Mailing Address - Fax:
Practice Address - Street 1:2664 FINCHWOOD AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-8574
Practice Address - Country:US
Practice Address - Phone:713-884-9579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX872445163W00000X
CA95159598163W00000X
NM62642367500000X
TX1011381367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse