Provider Demographics
NPI:1992167738
Name:IGWECHI, PHILOMINA (APN)
Entity type:Individual
Prefix:
First Name:PHILOMINA
Middle Name:
Last Name:IGWECHI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:PHILOMINA
Other - Middle Name:
Other - Last Name:IGWECHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:68 WINDING HILL DR
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-5671
Mailing Address - Country:US
Mailing Address - Phone:973-580-8159
Mailing Address - Fax:
Practice Address - Street 1:68 WINDING HILL DR
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-5671
Practice Address - Country:US
Practice Address - Phone:973-580-8159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00508400363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health