Provider Demographics
NPI:1417090549
Name:PRISCILLA NWACHUKWU
Entity Type:Organization
Organization Name:PRISCILLA NWACHUKWU
Other - Org Name:PRISCILLA NWACHUKWU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:NWACHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:781-894-3600
Mailing Address - Street 1:19 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1714
Mailing Address - Country:US
Mailing Address - Phone:781-784-0141
Mailing Address - Fax:781-250-8488
Practice Address - Street 1:19 HENRY ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-1714
Practice Address - Country:US
Practice Address - Phone:781-784-0141
Practice Address - Fax:781-250-8488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2011-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA194268313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA194268OtherNURSE PRACTITIONER
MA194268OtherNURSE PRACTITIONER