Provider Demographics
NPI:1598253908
Name:NWAGBARA, CHINONYELUM DORIS (MD)
Entity Type:Individual
Prefix:
First Name:CHINONYELUM
Middle Name:DORIS
Last Name:NWAGBARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHINONYELUM
Other - Middle Name:DORIS
Other - Last Name:ELUI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1453 E BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105
Mailing Address - Country:US
Mailing Address - Phone:318-681-5000
Mailing Address - Fax:404-756-1313
Practice Address - Street 1:1453 E BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105
Practice Address - Country:US
Practice Address - Phone:318-681-5000
Practice Address - Fax:404-756-1313
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA328832208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program