Provider Demographics
NPI:1801565312
Name:IWERIEBOR, NKECHI LUCY
Entity type:Individual
Prefix:
First Name:NKECHI
Middle Name:LUCY
Last Name:IWERIEBOR
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 1:5050 SHERIFF RD NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-5539
Mailing Address - Country:US
Mailing Address - Phone:202-725-0260
Mailing Address - Fax:202-635-5780
Practice Address - Street 1:1731 BUNKER HILL RD NE STE 269
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-3026
Practice Address - Country:US
Practice Address - Phone:202-635-5756
Practice Address - Fax:202-635-5780
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12965374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide