Provider Demographics
NPI:1235504663
Name:NWOSU, IKECHUKWU WILSON (NP-C)
Entity Type:Individual
Prefix:
First Name:IKECHUKWU
Middle Name:WILSON
Last Name:NWOSU
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 MARTIN LUTHER KING JR AVE SE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-7024
Mailing Address - Country:US
Mailing Address - Phone:202-889-7901
Mailing Address - Fax:202-315-0369
Practice Address - Street 1:2041 MARTIN LUTHER KING JR AVE SE
Practice Address - Street 2:SUIT 303
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-7024
Practice Address - Country:US
Practice Address - Phone:202-889-7901
Practice Address - Fax:202-610-3095
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1023532363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily