Provider Demographics
NPI:1760122451
Name:IHEDIWA, NGOZI CHINEDU
Entity Type:Individual
Prefix:
First Name:NGOZI
Middle Name:CHINEDU
Last Name:IHEDIWA
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 1:7915 VALLEY BEND DR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-3944
Mailing Address - Country:US
Mailing Address - Phone:256-348-3811
Mailing Address - Fax:
Practice Address - Street 1:7915 VALLEY BEND DR SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-3944
Practice Address - Country:US
Practice Address - Phone:256-348-3811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL964-070342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company