Provider Demographics
NPI:1912034653
Name:NWACHUKU, NNADOZIE I
Entity Type:Individual
Prefix:MR
First Name:NNADOZIE
Middle Name:I
Last Name:NWACHUKU
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 1:4305 MURVEN PARK LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-9501
Mailing Address - Country:US
Mailing Address - Phone:540-891-4336
Mailing Address - Fax:
Practice Address - Street 1:10620 SPOTSYLVANIA AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-2637
Practice Address - Country:US
Practice Address - Phone:540-891-4336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies