Provider Demographics
NPI:1396195996
Name:NWANKWO, GLORY (NP)
Entity Type:Individual
Prefix:
First Name:GLORY
Middle Name:
Last Name:NWANKWO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 1ST AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2287
Mailing Address - Country:US
Mailing Address - Phone:206-561-3933
Mailing Address - Fax:206-895-1274
Practice Address - Street 1:600 1ST AVE STE 102
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2287
Practice Address - Country:US
Practice Address - Phone:206-895-1259
Practice Address - Fax:206-895-1274
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004711363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily