Provider Demographics
NPI:1467980078
Name:NWAGWU, QUEEN IFEOMA
Entity Type:Individual
Prefix:
First Name:QUEEN
Middle Name:IFEOMA
Last Name:NWAGWU
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 1:1707 L ST NW STE 900
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-4208
Mailing Address - Country:US
Mailing Address - Phone:202-829-1111
Mailing Address - Fax:
Practice Address - Street 1:1845 HARVARD ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2380
Practice Address - Country:US
Practice Address - Phone:202-462-4033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12763374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA12763OtherHHA
DCHHA12763Medicaid