Provider Demographics
NPI:1447947064
Name:ONCHOKE, THOMAS MWEMBI
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:MWEMBI
Last Name:ONCHOKE
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 1:4600 LYDIA LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-2246
Mailing Address - Country:US
Mailing Address - Phone:612-386-1296
Mailing Address - Fax:
Practice Address - Street 1:4600 LYDIA LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-2246
Practice Address - Country:US
Practice Address - Phone:612-386-1296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1111756363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health