Provider Demographics
NPI:1336837574
Name:MBAWUIKE, CONCILIA (CNP)
Entity type:Individual
Prefix:
First Name:CONCILIA
Middle Name:
Last Name:MBAWUIKE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12380 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44130-1043
Mailing Address - Country:US
Mailing Address - Phone:216-672-3100
Mailing Address - Fax:216-362-0677
Practice Address - Street 1:5372 FALLOWATER LN STE 200
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-0909
Practice Address - Country:US
Practice Address - Phone:216-672-3100
Practice Address - Fax:216-362-0677
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024186984363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care