Provider Demographics
NPI:1508389768
Name:NWANKWO, HENRIETTA C (RN)
Entity Type:Individual
Prefix:MRS
First Name:HENRIETTA
Middle Name:C
Last Name:NWANKWO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 KATIE LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-8951
Mailing Address - Country:US
Mailing Address - Phone:608-444-3813
Mailing Address - Fax:
Practice Address - Street 1:5425 KATIE LN
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-8951
Practice Address - Country:US
Practice Address - Phone:608-444-3813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI154052-30163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical