Provider Demographics
NPI:1295456390
Name:NWANNEKA, EDWARD
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:NWANNEKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 SPARKLEBERRY TER NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-4050
Mailing Address - Country:US
Mailing Address - Phone:703-966-2184
Mailing Address - Fax:
Practice Address - Street 1:531 SPARKLEBERRY TER NE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4050
Practice Address - Country:US
Practice Address - Phone:703-966-2184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA615343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)