Provider Demographics
NPI:1528358850
Name:NWANEBU, IJEOMA GERTRUDE III (NP)
Entity Type:Individual
Prefix:MRS
First Name:IJEOMA
Middle Name:GERTRUDE
Last Name:NWANEBU
Suffix:III
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 NE 13TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5004
Mailing Address - Country:US
Mailing Address - Phone:405-271-5656
Mailing Address - Fax:
Practice Address - Street 1:6804 NW 135TH CIR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-5922
Practice Address - Country:US
Practice Address - Phone:405-773-9230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TR0400X
OKR0081415363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation