Provider Demographics
NPI:1740876002
Name:NWAOBILOR, OSINACHI SHAWN
Entity type:Individual
Prefix:
First Name:OSINACHI
Middle Name:SHAWN
Last Name:NWAOBILOR
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 1:12020 AUGUSTA DR
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9305
Mailing Address - Country:US
Mailing Address - Phone:301-281-5949
Mailing Address - Fax:
Practice Address - Street 1:12020 AUGUSTA DR
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9305
Practice Address - Country:US
Practice Address - Phone:301-281-5949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCNA20202903376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide