Provider Demographics
NPI:1427634120
Name:NWACHUKWU, IJEOMA PEACE
Entity type:Individual
Prefix:
First Name:IJEOMA
Middle Name:PEACE
Last Name:NWACHUKWU
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 1:405 SERRANO DR APT 6F
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-2268
Mailing Address - Country:US
Mailing Address - Phone:415-405-5098
Mailing Address - Fax:
Practice Address - Street 1:405 SERRANO DR APT 6F
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-2268
Practice Address - Country:US
Practice Address - Phone:415-405-5098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01151068376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17154544OtherKAISER PERMANENTE