Provider Demographics
NPI:1508306176
Name:NWAIBE, HENRIETTA CHINWENDU (NP)
Entity Type:Individual
Prefix:
First Name:HENRIETTA
Middle Name:CHINWENDU
Last Name:NWAIBE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 E GLADWICK ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3801
Mailing Address - Country:US
Mailing Address - Phone:310-567-0474
Mailing Address - Fax:
Practice Address - Street 1:1365 E GLADWICK ST
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3801
Practice Address - Country:US
Practice Address - Phone:310-567-0474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003901261QP2300X
CANP95003901363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care