Provider Demographics
NPI:1164062832
Name:NWACHUKWU, LOIS (APRN)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:NWACHUKWU
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1102
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61702-1102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4017 ROAD 2603RD ROAD
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:IL
Practice Address - Zip Code:60551
Practice Address - Country:US
Practice Address - Phone:309-827-3868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020551363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner