Provider Demographics
NPI:1245617901
Name:NWANCHA, THERESE
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:
Last Name:NWANCHA
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 1:7851 RIVERDALE RD APT 202
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-4004
Mailing Address - Country:US
Mailing Address - Phone:202-705-3114
Mailing Address - Fax:
Practice Address - Street 1:7851 RIVERDALE RD APT 202
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784
Practice Address - Country:US
Practice Address - Phone:202-705-3114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-01
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA 11235313M00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility