Provider Demographics
NPI:1922633718
Name:NWAKPUDA, CECILIA ADAORA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CECILIA
Middle Name:ADAORA
Last Name:NWAKPUDA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:CECILIA
Other - Middle Name:A
Other - Last Name:NWAKPUDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-0188
Mailing Address - Country:US
Mailing Address - Phone:520-682-4111
Mailing Address - Fax:520-818-3630
Practice Address - Street 1:899 N WILMOT RD STE B
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1712
Practice Address - Country:US
Practice Address - Phone:520-290-1100
Practice Address - Fax:520-290-8997
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5378685062363L00000X
AZ254598363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS53-78685-062OtherKSBN
AZ088273Medicaid