Provider Demographics
NPI:1932503687
Name:NKWOCHA, FONDA
Entity Type:Individual
Prefix:
First Name:FONDA
Middle Name:
Last Name:NKWOCHA
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 1:2550 S RECKER RD APT 149
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-5198
Mailing Address - Country:US
Mailing Address - Phone:385-313-2344
Mailing Address - Fax:
Practice Address - Street 1:2550 S RECKER RD APT 149
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-5198
Practice Address - Country:US
Practice Address - Phone:385-313-2344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-09
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider