Provider Demographics
NPI:1992944821
Name:NWADEYI, EMMANUEL OSITADINMA (PA-C)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:OSITADINMA
Last Name:NWADEYI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10420 HUFFINES DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-8569
Mailing Address - Country:US
Mailing Address - Phone:214-315-5255
Mailing Address - Fax:
Practice Address - Street 1:10420 HUFFINES DR
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-8569
Practice Address - Country:US
Practice Address - Phone:214-315-5255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04693363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA04693OtherPHYICIAN ASSISTANT LICENSE NUMBER