Provider Demographics
NPI:1710499181
Name:NWACHUKWU, JULIANA CHIOMA
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:CHIOMA
Last Name:NWACHUKWU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 RAILROAD AVENUE,
Mailing Address - Street 2:SUITE #16
Mailing Address - City:RAY
Mailing Address - State:ND
Mailing Address - Zip Code:58849
Mailing Address - Country:US
Mailing Address - Phone:701-448-2054
Mailing Address - Fax:
Practice Address - Street 1:104 MAIN ST
Practice Address - Street 2:
Practice Address - City:TURTLE LAKE
Practice Address - State:ND
Practice Address - Zip Code:58575-4001
Practice Address - Country:US
Practice Address - Phone:701-448-2054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR45102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily