Provider Demographics
NPI:1376812818
Name:NWAGWU, ISIDORE OBINNA (APRN)
Entity type:Individual
Prefix:
First Name:ISIDORE
Middle Name:OBINNA
Last Name:NWAGWU
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E CENTENNIAL DR
Mailing Address - Street 2:# 3&4
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-6571
Mailing Address - Country:US
Mailing Address - Phone:620-231-9873
Mailing Address - Fax:620-231-5062
Practice Address - Street 1:200 E CENTENNIAL DR
Practice Address - Street 2:# 3&4
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-6571
Practice Address - Country:US
Practice Address - Phone:620-231-9873
Practice Address - Fax:620-231-5062
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011039961363L00000X
KS53-75487-021363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201071080AMedicaid