Provider Demographics
NPI:1649756461
Name:NWOSU, ADAKU IJEOMA (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAKU
Middle Name:IJEOMA
Last Name:NWOSU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ADAKU
Other - Middle Name:IJEOMA
Other - Last Name:ANUEBUNWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:117 S 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-4312
Mailing Address - Country:US
Mailing Address - Phone:601-425-3033
Mailing Address - Fax:
Practice Address - Street 1:1 BROOKDALE PLZ
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3198
Practice Address - Country:US
Practice Address - Phone:718-240-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-15
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MS29093208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program