Provider Demographics
NPI:1417545443
Name:IWUNDU, THERESA CHINERO SR (NP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:CHINERO
Last Name:IWUNDU
Suffix:SR
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 1:1033 NEWTON ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-1763
Mailing Address - Country:US
Mailing Address - Phone:202-569-4778
Mailing Address - Fax:
Practice Address - Street 1:1033 NEWTON ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-1763
Practice Address - Country:US
Practice Address - Phone:202-569-4778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1014369163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice