Provider Demographics
NPI:1740788181
Name:NKWO, VINCENT NZENWA
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:NZENWA
Last Name:NKWO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 PARK RD NW APT C
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2560
Mailing Address - Country:US
Mailing Address - Phone:202-766-7420
Mailing Address - Fax:
Practice Address - Street 1:621 PARK RD NW APT C
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2560
Practice Address - Country:US
Practice Address - Phone:202-766-7420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-31
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13204251E00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health