Provider Demographics
NPI:1225862972
Name:NWABUCHE, IJEOMA JACQUELINE
Entity type:Individual
Prefix:
First Name:IJEOMA
Middle Name:JACQUELINE
Last Name:NWABUCHE
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 1:498 COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1362
Mailing Address - Country:US
Mailing Address - Phone:631-939-4465
Mailing Address - Fax:
Practice Address - Street 1:498 COLLEGE RD
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-1362
Practice Address - Country:US
Practice Address - Phone:631-939-4465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345710-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse