Provider Demographics
NPI:1558949073
Name:NWACHAN, NYAKEM M
Entity Type:Individual
Prefix:
First Name:NYAKEM
Middle Name:M
Last Name:NWACHAN
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 1:2503 ALLISON ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1254
Mailing Address - Country:US
Mailing Address - Phone:713-291-1929
Mailing Address - Fax:
Practice Address - Street 1:2503 ALLISON ST
Practice Address - Street 2:
Practice Address - City:MOUNT RAINIER
Practice Address - State:MD
Practice Address - Zip Code:20712-1254
Practice Address - Country:US
Practice Address - Phone:713-291-1929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide