Provider Demographics
NPI:1750710950
Name:NDUKWE, LILIAN NKIRU (MSN, FNP)
Entity type:Individual
Prefix:
First Name:LILIAN
Middle Name:NKIRU
Last Name:NDUKWE
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 E CARSON PLAZA DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3209
Mailing Address - Country:US
Mailing Address - Phone:310-965-6550
Mailing Address - Fax:310-965-6552
Practice Address - Street 1:454 E CARSON PLAZA DR
Practice Address - Street 2:SUITE 209
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3209
Practice Address - Country:US
Practice Address - Phone:310-965-6550
Practice Address - Fax:310-965-6552
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21943363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care