Provider Demographics
NPI:1699049577
Name:NWOBI, PRUDENCE C
Entity type:Individual
Prefix:
First Name:PRUDENCE
Middle Name:C
Last Name:NWOBI
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 1:72 W KINNEY ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-1104
Mailing Address - Country:US
Mailing Address - Phone:862-755-3118
Mailing Address - Fax:
Practice Address - Street 1:72 W KINNEY ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-1104
Practice Address - Country:US
Practice Address - Phone:862-755-3118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283842164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse