Provider Demographics
NPI:1841566486
Name:IWUALA, CALLISTA NGOZI (APN-C)
Entity type:Individual
Prefix:MRS
First Name:CALLISTA
Middle Name:NGOZI
Last Name:IWUALA
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:46 CRYSTAL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3546
Mailing Address - Country:US
Mailing Address - Phone:201-362-9916
Mailing Address - Fax:973-243-9861
Practice Address - Street 1:860 GROVE ST
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3601
Practice Address - Country:US
Practice Address - Phone:973-373-0805
Practice Address - Fax:973-243-9861
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00351900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily