Basic Information
| Provider Information | |||||||||
| NPI: | 1578859229 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NNABUIHE | ||||||||
| FirstName: | MIRIAM | ||||||||
| MiddleName: | UZOAMAKA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APN-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 GROVE STREET | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HADDON HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567969200 | ||||||||
| FaxNumber: | 8567969397 | ||||||||
| Practice Location | |||||||||
| Address1: | 302 HURFFVILLE CROSSKEYS RD STE A1 | ||||||||
| Address2: | |||||||||
| City: | SEWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080809206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565894610 | ||||||||
| FaxNumber: | 8565821624 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2011 | ||||||||
| LastUpdateDate: | 05/23/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 26NJ00320300 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 227754 | 01 | NJ | MEDICARE | OTHER | 0402583 | 05 | NJ | MEDICAID |