Provider Demographics
NPI:1912108697
Name:NWANKWO, NNEBUCHI
Entity Type:Individual
Prefix:
First Name:NNEBUCHI
Middle Name:
Last Name:NWANKWO
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 1:4428 LOUISBURG RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-4302
Mailing Address - Country:US
Mailing Address - Phone:919-872-7686
Mailing Address - Fax:919-872-7456
Practice Address - Street 1:4428 LOUISBURG RD
Practice Address - Street 2:SUITE 109
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-4302
Practice Address - Country:US
Practice Address - Phone:919-872-7686
Practice Address - Fax:919-872-7456
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-092648311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home