Basic Information
| Provider Information | |||||||||
| NPI: | 1073860466 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NWOKO | ||||||||
| FirstName: | JOSEPHINE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | GNP-BC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | NWACHUKWU | ||||||||
| OtherFirstName: | JOSEPHINE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherNameSuffix: | |||||||||
| OtherCredential: | GNP-BC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8601 VETERANS HWY | ||||||||
| Address2: | SUITE 211 | ||||||||
| City: | MILLERSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211081547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105538092 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8601 VETERANS HWY | ||||||||
| Address2: | SUITE 211 | ||||||||
| City: | MILLERSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211081547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105538092 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2012 | ||||||||
| LastUpdateDate: | 02/01/2016 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | R174691 | MD | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363LG0600X | RN1012764 | DC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.