Provider Demographics
NPI:1790410975
Name:NWACHUKWU, AMARACHI PATRICE
Entity Type:Individual
Prefix:
First Name:AMARACHI
Middle Name:PATRICE
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 1:360 W AVENUE 26 APT 340
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-1489
Mailing Address - Country:US
Mailing Address - Phone:320-309-3009
Mailing Address - Fax:
Practice Address - Street 1:360 W AVENUE 26 APT 340
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-1489
Practice Address - Country:US
Practice Address - Phone:320-309-3009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95088967163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse