Provider Demographics
NPI:1033654231
Name:NWACHUKWU, GLORIA CHIDINMA
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:CHIDINMA
Last Name:NWACHUKWU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 N HIGH SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-3694
Mailing Address - Country:US
Mailing Address - Phone:317-605-2630
Mailing Address - Fax:317-842-6441
Practice Address - Street 1:602 N HIGH SCHOOL RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-4621
Practice Address - Country:US
Practice Address - Phone:317-605-2630
Practice Address - Fax:317-842-6441
Is Sole Proprietor?:No
Enumeration Date:2016-12-23
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006808A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily