Provider Demographics
NPI:1740776632
Name:NWOKORO, NGWANMA ALVANIS (CRNP-FAMILY)
Entity Type:Individual
Prefix:
First Name:NGWANMA
Middle Name:ALVANIS
Last Name:NWOKORO
Suffix:
Gender:F
Credentials:CRNP-FAMILY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 GARRISON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-2308
Mailing Address - Country:US
Mailing Address - Phone:410-945-2289
Mailing Address - Fax:410-945-4255
Practice Address - Street 1:2300 GARRISON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-2308
Practice Address - Country:US
Practice Address - Phone:410-945-2289
Practice Address - Fax:410-945-4255
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR195086363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily