Provider Demographics
NPI:1124411129
Name:NWANKWO, OZODIMMA (MPH, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:OZODIMMA
Middle Name:
Last Name:NWANKWO
Suffix:
Gender:F
Credentials:MPH, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15712 DORSET RD APT T2
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5349
Mailing Address - Country:US
Mailing Address - Phone:310-505-1936
Mailing Address - Fax:
Practice Address - Street 1:15712 DORSET RD APT T2
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5349
Practice Address - Country:US
Practice Address - Phone:310-505-1936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-15
Last Update Date:2015-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3758133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered