Provider Demographics
NPI:1417431644
Name:NWACHOKOR, ALISA
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:NWACHOKOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17510 W GRAND PKWY S STE 380
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2649
Mailing Address - Country:US
Mailing Address - Phone:346-616-0038
Mailing Address - Fax:
Practice Address - Street 1:17510 W. GRAND PARKWAY SOUTH
Practice Address - Street 2:SUITE #380
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-7747
Practice Address - Country:US
Practice Address - Phone:346-616-0038
Practice Address - Fax:346-843-2618
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered