Provider Demographics
NPI:1134726235
Name:NWIGWE, MATILDA CHINYELU
Entity type:Individual
Prefix:
First Name:MATILDA
Middle Name:CHINYELU
Last Name:NWIGWE
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 1:3914 GOOSE CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-1070
Mailing Address - Country:US
Mailing Address - Phone:214-664-0059
Mailing Address - Fax:
Practice Address - Street 1:3914 GOOSE CREEK PKWY
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-1070
Practice Address - Country:US
Practice Address - Phone:214-664-0059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1005932163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse