Basic Information
| Provider Information | |||||||||
| NPI: | 1528568458 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ASONYE | ||||||||
| FirstName: | LINUS | ||||||||
| MiddleName: | O | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 DE HAES AVE | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752242840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4696716295 | ||||||||
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| Practice Location | |||||||||
| Address1: | 505 W CENTERVILLE RD | ||||||||
| Address2: | |||||||||
| City: | GARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750415445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722783566 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2018 | ||||||||
| LastUpdateDate: | 02/16/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 325546 | TX | Y | Nursing Service Providers | Licensed Vocational Nurse |
ID Information
| ID | Type | State | Issuer | Description | 164X00000X | 05 | TX | MEDICAID |