Provider Demographics
NPI:1306477013
Name:ONYANGO, SAMWEL NYAGETIRIA
Entity type:Individual
Prefix:
First Name:SAMWEL
Middle Name:NYAGETIRIA
Last Name:ONYANGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 TAMPA BAY WAY
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4022
Mailing Address - Country:US
Mailing Address - Phone:682-521-9726
Mailing Address - Fax:
Practice Address - Street 1:1314 LAKE ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-4581
Practice Address - Country:US
Practice Address - Phone:817-810-0660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX881729163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse