1235564162 NPI number — MS. CECILIA NKASIOBI NWAUCHE NP

Table of content: MS. CECILIA NKASIOBI NWAUCHE NP (NPI 1235564162)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235564162 NPI number — MS. CECILIA NKASIOBI NWAUCHE NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NWAUCHE
Provider First Name:
CECILIA
Provider Middle Name:
NKASIOBI
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235564162
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
424 RUNNING HORSE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAXHAW
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28173-7232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-575-5064
Provider Business Mailing Address Fax Number:
704-243-7506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6101 IDLEWILD RD
Provider Second Line Business Practice Location Address:
SUITE 315
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28212-0517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-716-9898
Provider Business Practice Location Address Fax Number:
704-716-9838
Provider Enumeration Date:
09/11/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  5006397 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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