Provider Demographics
NPI:1164287637
Name:NWAOKOLO, BLESSING AFUMATA
Entity Type:Individual
Prefix:
First Name:BLESSING
Middle Name:AFUMATA
Last Name:NWAOKOLO
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 1:412 ALBA AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:NE
Mailing Address - Zip Code:68869-1370
Mailing Address - Country:US
Mailing Address - Phone:443-529-7306
Mailing Address - Fax:
Practice Address - Street 1:2620 W FAIDLEY AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4297
Practice Address - Country:US
Practice Address - Phone:308-398-6725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE167892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily