Provider Demographics
NPI:1558535609
Name:NWISU, EMMANUEL AZUBUIKE (PA-C)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:AZUBUIKE
Last Name:NWISU
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E HOBSONWAY STE C
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225-1700
Mailing Address - Country:US
Mailing Address - Phone:760-922-0446
Mailing Address - Fax:
Practice Address - Street 1:101 E HOBSONWAY STE C
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1700
Practice Address - Country:US
Practice Address - Phone:760-922-0446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-19
Last Update Date:2008-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12251363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical