Provider Demographics
NPI:1811330590
Name:NNAMUCHI, EDITH GINIKANWA
Entity type:Individual
Prefix:MS
First Name:EDITH
Middle Name:GINIKANWA
Last Name:NNAMUCHI
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 1:2920 W HIGHLAND BLVD APT 212
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-4310
Mailing Address - Country:US
Mailing Address - Phone:414-208-0344
Mailing Address - Fax:
Practice Address - Street 1:2920 W HIGHLAND BLVD APT 212
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-4310
Practice Address - Country:US
Practice Address - Phone:414-208-0344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI315764-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse