Provider Demographics
NPI:1770102071
Name:NWABUKO, LINDA N
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:N
Last Name:NWABUKO
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 1:10550 N CENTRAL EXPY APT 356
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2444
Mailing Address - Country:US
Mailing Address - Phone:214-289-5211
Mailing Address - Fax:
Practice Address - Street 1:10550 N CENTRAL EXPY APT 356
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2444
Practice Address - Country:US
Practice Address - Phone:214-289-5211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX936967163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse