Provider Demographics
NPI:1134706518
Name:CHINWUBA, EBELECHUKWU AMAKA (LPN)
Entity type:Individual
Prefix:
First Name:EBELECHUKWU
Middle Name:AMAKA
Last Name:CHINWUBA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9058 MARIA WAY
Mailing Address - Street 2:
Mailing Address - City:MANASSAS PARK
Mailing Address - State:VA
Mailing Address - Zip Code:20111-7052
Mailing Address - Country:US
Mailing Address - Phone:240-601-1386
Mailing Address - Fax:
Practice Address - Street 1:2112 F ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2715
Practice Address - Country:US
Practice Address - Phone:202-349-3209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1008244164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse