Provider Demographics
NPI:1023580883
Name:FOOT AND ANKLE WELLNESS CENTER
Entity Type:Organization
Organization Name:FOOT AND ANKLE WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IJEOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:NWUJU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:240-723-0105
Mailing Address - Street 1:1160 VARNUM ST NE STE 200
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2106
Mailing Address - Country:US
Mailing Address - Phone:202-635-8306
Mailing Address - Fax:
Practice Address - Street 1:1160 VARNUM ST NE STE 200
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2106
Practice Address - Country:US
Practice Address - Phone:202-635-8306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-18
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty