Provider Demographics
NPI:1942916796
Name:NWADIKE, NWAKANMA VIVIAN (APN)
Entity Type:Individual
Prefix:MRS
First Name:NWAKANMA
Middle Name:VIVIAN
Last Name:NWADIKE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:NWAKANMA
Other - Middle Name:V
Other - Last Name:NWADIKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:1308 BRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-2374
Mailing Address - Country:US
Mailing Address - Phone:973-978-2319
Mailing Address - Fax:
Practice Address - Street 1:1501 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-4032
Practice Address - Country:US
Practice Address - Phone:908-526-8370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01366300363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health