Provider Demographics
NPI:1134972052
Name:NWACHUKU, MAGNSNOH MARYANNE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MAGNSNOH
Middle Name:MARYANNE
Last Name:NWACHUKU
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 W MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2900
Mailing Address - Country:US
Mailing Address - Phone:774-386-4147
Mailing Address - Fax:
Practice Address - Street 1:21 SW CUTOFF STE 108
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-2135
Practice Address - Country:US
Practice Address - Phone:508-344-7530
Practice Address - Fax:949-437-2186
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2273516363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health