Provider Demographics
NPI:1407379068
Name:NWAOLU, CHRISTIANA NKWACHI (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:CHRISTIANA
Middle Name:NKWACHI
Last Name:NWAOLU
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4722 GAINSBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-2379
Mailing Address - Country:US
Mailing Address - Phone:703-978-1869
Mailing Address - Fax:
Practice Address - Street 1:12225 AMOS LN STE 101
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-7108
Practice Address - Country:US
Practice Address - Phone:540-755-7911
Practice Address - Fax:540-755-7903
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175098164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse