Provider Demographics
NPI:1255738175
Name:NWABIKWU, SALLY
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:NWABIKWU
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 1:615 MISSOURI AVE NW
Mailing Address - Street 2:APT 3
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-2060
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:615 MISSOURI AVE NW
Practice Address - Street 2:APT 3
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2060
Practice Address - Country:US
Practice Address - Phone:917-915-0426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00133603376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide