Provider Demographics
NPI:1750951653
Name:NNODIM, NGOZI IHUNANYACHI (NP)
Entity type:Individual
Prefix:
First Name:NGOZI
Middle Name:IHUNANYACHI
Last Name:NNODIM
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 1:13361 DIAMOND RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-8340
Mailing Address - Country:US
Mailing Address - Phone:804-943-7510
Mailing Address - Fax:
Practice Address - Street 1:13361 DIAMOND RIDGE DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-8340
Practice Address - Country:US
Practice Address - Phone:804-943-7510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179953363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care