Provider Demographics
NPI:1811015100
Name:NWANDU, ETHEL (RN)
Entity Type:Individual
Prefix:MRS
First Name:ETHEL
Middle Name:
Last Name:NWANDU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22606 MORALIA DR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-2675
Mailing Address - Country:US
Mailing Address - Phone:951-358-6919
Mailing Address - Fax:951-358-7312
Practice Address - Street 1:9990 COUNTY FARM RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3542
Practice Address - Country:US
Practice Address - Phone:951-358-6919
Practice Address - Fax:951-358-7312
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA551054163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse