Provider Demographics
NPI:1215637863
Name:NWAGWU, VICTOR TOOCHUKWU
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:TOOCHUKWU
Last Name:NWAGWU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-1344
Mailing Address - Country:US
Mailing Address - Phone:804-372-5476
Mailing Address - Fax:804-509-0531
Practice Address - Street 1:3611 BOULEVARD
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1344
Practice Address - Country:US
Practice Address - Phone:804-372-5476
Practice Address - Fax:804-509-0531
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024186638363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health