Provider Demographics
NPI:1720474869
Name:ANAELE-DIBIA IWUAGWU, VICTORIA CHIAMAKA (RN-BSN)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:CHIAMAKA
Last Name:ANAELE-DIBIA IWUAGWU
Suffix:
Gender:F
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11847 W FLAGG AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-2225
Mailing Address - Country:US
Mailing Address - Phone:414-573-3126
Mailing Address - Fax:
Practice Address - Street 1:11847 W FLAGG AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-2225
Practice Address - Country:US
Practice Address - Phone:414-573-3126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041386270163W00000X
NC234126163W00000X
WI222085-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse