Provider Demographics
NPI:1801325949
Name:NWUFOR, IFEOMA (FNP/PMHNP-BC)
Entity type:Individual
Prefix:
First Name:IFEOMA
Middle Name:
Last Name:NWUFOR
Suffix:
Gender:F
Credentials:FNP/PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17817 HAZELWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-7481
Mailing Address - Country:US
Mailing Address - Phone:424-653-7426
Mailing Address - Fax:
Practice Address - Street 1:1204 W GARDENA BLVD STE B
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-5923
Practice Address - Country:US
Practice Address - Phone:310-767-7833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-11
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006219363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily