Provider Demographics
NPI:1740950666
Name:NWACHUKWU, CHUKWUZITERE Y
Entity type:Individual
Prefix:
First Name:CHUKWUZITERE
Middle Name:Y
Last Name:NWACHUKWU
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 1:5430 NEWTON ST
Mailing Address - Street 2:APT 7
Mailing Address - City:HYATSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784
Mailing Address - Country:US
Mailing Address - Phone:240-726-0583
Mailing Address - Fax:
Practice Address - Street 1:5430 NEWTON ST
Practice Address - Street 2:APT 7
Practice Address - City:HYATSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784
Practice Address - Country:US
Practice Address - Phone:240-726-0583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCNA0000608861Medicaid