Provider Demographics
NPI:1447758578
Name:NDUBUEZE, MCMAURICE C (RN)
Entity Type:Individual
Prefix:
First Name:MCMAURICE
Middle Name:C
Last Name:NDUBUEZE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 COLLEY AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-2166
Mailing Address - Country:US
Mailing Address - Phone:757-321-0064
Mailing Address - Fax:
Practice Address - Street 1:5215 COLLEY AVE STE 112
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23508-2166
Practice Address - Country:US
Practice Address - Phone:757-321-0064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X, 374U00000X, 376J00000X
VA0001264587163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker