Provider Demographics
NPI:1447886080
Name:NWANKWO, EMMANUEL CHIDOBE
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:CHIDOBE
Last Name:NWANKWO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9861 DELLCASTLE RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-1324
Mailing Address - Country:US
Mailing Address - Phone:240-678-8994
Mailing Address - Fax:240-607-7111
Practice Address - Street 1:9861 DELLCASTLE RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-1324
Practice Address - Country:US
Practice Address - Phone:240-678-8994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR195263163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDN520229115300Medicaid