Provider Demographics
NPI:1487943239
Name:NNAMANI, IJEOMA C (MD)
Entity type:Individual
Prefix:DR
First Name:IJEOMA
Middle Name:C
Last Name:NNAMANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IJEOMA
Other - Middle Name:C
Other - Last Name:NNOLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:350 WESTPARK WAY STE 123
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-3734
Mailing Address - Country:US
Mailing Address - Phone:817-267-3065
Mailing Address - Fax:817-545-9097
Practice Address - Street 1:350 WESTPARK WAY STE 123
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3734
Practice Address - Country:US
Practice Address - Phone:817-267-3065
Practice Address - Fax:817-545-9097
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1376208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics