Provider Demographics
NPI:1467804997
Name:NWADIKE, LINDA ADAEZE (MSN, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ADAEZE
Last Name:NWADIKE
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3056 LAWSON DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-6418
Mailing Address - Country:US
Mailing Address - Phone:678-230-3322
Mailing Address - Fax:770-319-7446
Practice Address - Street 1:3905 DUE WEST RD NW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-1019
Practice Address - Country:US
Practice Address - Phone:678-290-5740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-08
Last Update Date:2016-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN157496363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA363LF0000XOtherTYPE 1 WITH 'NURSE PRACTITIONER - FAMILY'