Provider Demographics
NPI:1992297436
Name:NWOSU, SAM
Entity type:Individual
Prefix:MR
First Name:SAM
Middle Name:
Last Name:NWOSU
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 1:5510 HEWITTS CV
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-4139
Mailing Address - Country:US
Mailing Address - Phone:214-518-8851
Mailing Address - Fax:469-304-0432
Practice Address - Street 1:5510 HEWITTS CV
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-4139
Practice Address - Country:US
Practice Address - Phone:214-518-8851
Practice Address - Fax:469-304-0432
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor