Provider Demographics
NPI:1588484703
Name:NWALA, PRECIOUS CHIDIMMA (NP)
Entity type:Individual
Prefix:DR
First Name:PRECIOUS
Middle Name:CHIDIMMA
Last Name:NWALA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:DR
Other - First Name:PRECIOUS
Other - Middle Name:CHIDIMMA
Other - Last Name:NWALA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:2517 FARMCREST DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-3119
Mailing Address - Country:US
Mailing Address - Phone:757-672-2025
Mailing Address - Fax:
Practice Address - Street 1:2517 FARMCREST DR
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-3119
Practice Address - Country:US
Practice Address - Phone:757-672-2025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024191339363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology