Provider Demographics
NPI:1952687501
Name:NWACHUKWU, ALEXANDER (RN)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:NWACHUKWU
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12714 W EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-4612
Mailing Address - Country:US
Mailing Address - Phone:414-630-3401
Mailing Address - Fax:
Practice Address - Street 1:12714 W EUCLID AVE
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-4612
Practice Address - Country:US
Practice Address - Phone:414-630-3401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI179698-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse