Provider Demographics
NPI:1487824785
Name:NWANKPA, SUNDAY
Entity Type:Individual
Prefix:MR
First Name:SUNDAY
Middle Name:
Last Name:NWANKPA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 S MANNHEIM RD
Mailing Address - Street 2:212
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-2561
Mailing Address - Country:US
Mailing Address - Phone:708-343-4704
Mailing Address - Fax:708-343-4941
Practice Address - Street 1:1107 S MANNHEIM RD
Practice Address - Street 2:212
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-2561
Practice Address - Country:US
Practice Address - Phone:708-343-4704
Practice Address - Fax:708-343-4941
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000988332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6394850001Medicare NSC