Provider Demographics
NPI:1407093685
Name:MBAWUIKE, VIRGILIUS UZO
Entity Type:Individual
Prefix:MR
First Name:VIRGILIUS
Middle Name:UZO
Last Name:MBAWUIKE
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 1:10 PINEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-1020
Mailing Address - Country:US
Mailing Address - Phone:617-233-5829
Mailing Address - Fax:
Practice Address - Street 1:10 PINEWOOD ST
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-1020
Practice Address - Country:US
Practice Address - Phone:617-233-5829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA236261163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse