Provider Demographics
NPI:1669747416
Name:NNADI, CICILIA IJEOMA (NP)
Entity type:Individual
Prefix:
First Name:CICILIA
Middle Name:IJEOMA
Last Name:NNADI
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 1:5002 13TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-6910
Mailing Address - Country:US
Mailing Address - Phone:202-714-0188
Mailing Address - Fax:
Practice Address - Street 1:2041 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-0001
Practice Address - Country:US
Practice Address - Phone:202-865-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN63515363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1988Medicaid
1988Medicare UPIN
DC1988639Medicare Oscar/Certification
1988Medicare PIN
DC1988Medicare UPIN
1988639Medicare Oscar/Certification
DC1988Medicaid
DC1988369490Medicare NSC