| Doctor Name: | MODESTA OBIAGELI ONYIA |
| NPI Number: | 1013340520 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 679518 |
| Business Practice Address: | 205 E University Ave Suite 157 Georgetown, TX - 786266814 |
| Business Phone Number: | 5128689078 |
| Business Fax Number: | 5128190646 |
| Mailing Address: | 1913 Mesa Ct, GARLAND |
| State: | TX |
| Postal Code: | 750408289 |
| Phone Number: | 2146299639 |
| Fax Number: | 9722784606 |
| NPI Enumeration Date: | 08/20/2013 |
| NPI Last Update Date: | 08/20/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 679518 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |