Provider Demographics
NPI:1720895584
Name:ONYEANUSI, LETISHA M
Entity type:Individual
Prefix:
First Name:LETISHA
Middle Name:M
Last Name:ONYEANUSI
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 1:121 BECKS WOODS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-3853
Mailing Address - Country:US
Mailing Address - Phone:302-261-5600
Mailing Address - Fax:
Practice Address - Street 1:121 BECKS WOODS DR STE 100
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-3853
Practice Address - Country:US
Practice Address - Phone:954-638-0951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG0013018363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily