Provider Demographics
NPI:1366024812
Name:NWACHUKWU, IKECHUKWU I
Entity Type:Individual
Prefix:
First Name:IKECHUKWU
Middle Name:I
Last Name:NWACHUKWU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9220 TRADERS XING APT E
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1626
Mailing Address - Country:US
Mailing Address - Phone:301-531-0450
Mailing Address - Fax:
Practice Address - Street 1:9220 TRADERS XING APT E
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-1626
Practice Address - Country:US
Practice Address - Phone:301-531-0450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-24
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR245899163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse