Provider Demographics
NPI:1104249069
Name:NWAIWU, NNENNA
Entity type:Individual
Prefix:
First Name:NNENNA
Middle Name:
Last Name:NWAIWU
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 1:5626 WHITFIELD CHAPEL RD
Mailing Address - Street 2:APT.304
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2551
Mailing Address - Country:US
Mailing Address - Phone:240-646-6917
Mailing Address - Fax:
Practice Address - Street 1:5626 WHITFIELD CHAPEL RD
Practice Address - Street 2:APT.304
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2551
Practice Address - Country:US
Practice Address - Phone:240-646-6917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide