Provider Demographics
NPI:1427749514
Name:OFEINMUN, AITENOBHAN CYNTHIA
Entity type:Individual
Prefix:
First Name:AITENOBHAN
Middle Name:CYNTHIA
Last Name:OFEINMUN
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 1:2700 BONITA DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-0268
Mailing Address - Country:US
Mailing Address - Phone:469-285-2504
Mailing Address - Fax:
Practice Address - Street 1:301 40TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79404-2746
Practice Address - Country:US
Practice Address - Phone:806-743-9355
Practice Address - Fax:806-743-9363
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1119544363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health