Provider Demographics
NPI:1700169596
Name:NWACHUKWU, VIVIAN
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:NWACHUKWU
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 1:1140 KILDAIRE FARM RD STE 208
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4597
Mailing Address - Country:US
Mailing Address - Phone:919-282-4820
Mailing Address - Fax:
Practice Address - Street 1:1140 KILDAIRE FARM RD
Practice Address - Street 2:SUITE 108, ROOM 13
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4562
Practice Address - Country:US
Practice Address - Phone:919-282-4820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2019-03-01
Deactivation Date:2011-10-13
Deactivation Code:
Reactivation Date:2015-09-22
Provider Licenses
StateLicense IDTaxonomies
NCHC44503747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant