Provider Demographics
NPI:1811409212
Name:IWUJI, ADANNA
Entity Type:Individual
Prefix:
First Name:ADANNA
Middle Name:
Last Name:IWUJI
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 1:601 S RANCHO DR STE D34
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4874
Mailing Address - Country:US
Mailing Address - Phone:702-471-0051
Mailing Address - Fax:
Practice Address - Street 1:601 S RANCHO DR STE D34
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4874
Practice Address - Country:US
Practice Address - Phone:702-471-0051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2023-06-26
Deactivation Date:2022-06-16
Deactivation Code:
Reactivation Date:2022-07-28
Provider Licenses
StateLicense IDTaxonomies
NV863093363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily