Provider Demographics
NPI:1659082998
Name:IGWEZE, DILICHUKWU OMAZUYA (LPN)
Entity Type:Individual
Prefix:
First Name:DILICHUKWU
Middle Name:OMAZUYA
Last Name:IGWEZE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7928 QUIDDITCH LN
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-7540
Mailing Address - Country:US
Mailing Address - Phone:301-814-1711
Mailing Address - Fax:
Practice Address - Street 1:7928 QUIDDITCH LN
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-7540
Practice Address - Country:US
Practice Address - Phone:301-814-1711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP50760164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse