Provider Demographics
NPI:1861966632
Name:NWANI, CHIBUIKEM VICTOR (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:CHIBUIKEM
Middle Name:VICTOR
Last Name:NWANI
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9258 MARLEMONT CIR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7604
Mailing Address - Country:US
Mailing Address - Phone:213-479-4878
Mailing Address - Fax:
Practice Address - Street 1:9258 MARLEMONT CIR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7604
Practice Address - Country:US
Practice Address - Phone:213-479-4878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA692129163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical