Provider Demographics
NPI:1326780404
Name:IWUNZE, NNENNA
Entity type:Individual
Prefix:
First Name:NNENNA
Middle Name:
Last Name:IWUNZE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WOODBINE ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3243
Mailing Address - Country:US
Mailing Address - Phone:617-833-8306
Mailing Address - Fax:617-696-0779
Practice Address - Street 1:1 WOODBINE ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3243
Practice Address - Country:US
Practice Address - Phone:617-833-8306
Practice Address - Fax:617-696-0779
Is Sole Proprietor?:No
Enumeration Date:2022-04-10
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN253783363LP0808X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health