Provider Demographics
NPI:1629360029
Name:NWACHUKWU, SOLOMON CHIMAOBIM (RN)
Entity Type:Individual
Prefix:MR
First Name:SOLOMON
Middle Name:CHIMAOBIM
Last Name:NWACHUKWU
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LEWIS ST REAR SUITE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-2629
Mailing Address - Country:US
Mailing Address - Phone:781-930-9300
Mailing Address - Fax:
Practice Address - Street 1:10 LEWIS ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-2629
Practice Address - Country:US
Practice Address - Phone:781-475-7864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR156749163WC1500X
MA217716163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health