Provider Demographics
NPI:1952123986
Name:NAMWILA, JACKEE C (BCPA)
Entity type:Individual
Prefix:
First Name:JACKEE
Middle Name:C
Last Name:NAMWILA
Suffix:
Gender:F
Credentials:BCPA
Other - Prefix:MS
Other - First Name:JACKEE
Other - Middle Name:C
Other - Last Name:NAMWILA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCPA
Mailing Address - Street 1:1227 ALBANY AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-5635
Mailing Address - Country:US
Mailing Address - Phone:646-864-4631
Mailing Address - Fax:212-954-5151
Practice Address - Street 1:442 5TH AVE # 1536
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-2794
Practice Address - Country:US
Practice Address - Phone:646-864-4631
Practice Address - Fax:212-954-5151
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator