Provider Demographics
NPI:1427116078
Name:NWOKORIE, TIMOTHY O
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:O
Last Name:NWOKORIE
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 1:1165 CALVERT DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2303
Mailing Address - Country:US
Mailing Address - Phone:972-748-8009
Mailing Address - Fax:972-291-7520
Practice Address - Street 1:1165 CALVERT DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2303
Practice Address - Country:US
Practice Address - Phone:972-748-8009
Practice Address - Fax:972-291-7520
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX198685164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse