Provider Demographics
NPI:1932470986
Name:NNAWUBA, PAULINE CHINASA
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:CHINASA
Last Name:NNAWUBA
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 BLACK BRANCH WAY
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-6229
Mailing Address - Country:US
Mailing Address - Phone:301-390-1766
Mailing Address - Fax:
Practice Address - Street 1:9475 LOTTSFORD RD
Practice Address - Street 2:SUITE 250
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5357
Practice Address - Country:US
Practice Address - Phone:301-636-6504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR183831101YM0800X, 163W00000X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163W00000XNursing Service ProvidersRegistered Nurse