Provider Demographics
NPI:1083283634
Name:NWABUOBI, IKECHUKWU CHARLES (NP)
Entity Type:Individual
Prefix:MR
First Name:IKECHUKWU
Middle Name:CHARLES
Last Name:NWABUOBI
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 E THORNTON AVE APT W202
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-7657
Mailing Address - Country:US
Mailing Address - Phone:917-605-4369
Mailing Address - Fax:
Practice Address - Street 1:72047 DINAH SHORE DR STE C4
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1783
Practice Address - Country:US
Practice Address - Phone:760-770-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017581363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health