Provider Demographics
NPI:1245591593
Name:NWASURUBA, CHUKWUEMEKA ANOKWURU
Entity type:Individual
Prefix:MR
First Name:CHUKWUEMEKA
Middle Name:ANOKWURU
Last Name:NWASURUBA
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:CHUKWUEMEKA
Other - Middle Name:ANOKWURU
Other - Last Name:NWASURUBA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:7505 HILL BURNE DR
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-5869
Mailing Address - Country:US
Mailing Address - Phone:240-505-6268
Mailing Address - Fax:
Practice Address - Street 1:7505 HILL BURNE DR
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-5869
Practice Address - Country:US
Practice Address - Phone:240-505-6268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP42143164W00000X
DCLPN1003617164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse