Provider Demographics
NPI:1164199766
Name:NWADIKE, CLAVE NONYE (CRNP-FAMILY)
Entity Type:Individual
Prefix:
First Name:CLAVE
Middle Name:NONYE
Last Name:NWADIKE
Suffix:
Gender:M
Credentials:CRNP-FAMILY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9603 TOUCAN DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-4780
Mailing Address - Country:US
Mailing Address - Phone:240-705-0967
Mailing Address - Fax:
Practice Address - Street 1:9603 TOUCAN DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-4780
Practice Address - Country:US
Practice Address - Phone:240-705-0967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR216097163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR216097OtherMARYLAND BOARD OR NURSING