Provider Demographics
NPI:1922281229
Name:NWAOGWUGWU, BERNARD NGONADI (LVN)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:NGONADI
Last Name:NWAOGWUGWU
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13520 KORNBLUM AVE APT 136
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-7648
Mailing Address - Country:US
Mailing Address - Phone:310-429-2062
Mailing Address - Fax:310-973-4912
Practice Address - Street 1:13520 KORNBLUM AVE APT 136
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-7648
Practice Address - Country:US
Practice Address - Phone:310-429-2062
Practice Address - Fax:310-973-4912
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALVN 207577164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse