Provider Demographics
NPI:1881164358
Name:ADIGWU, THERESA NGOZI (CRNP)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:NGOZI
Last Name:ADIGWU
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:THERESA
Other - Middle Name:NGOZI
Other - Last Name:ODOGWU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2208 CHATHAM WAY
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-3959
Mailing Address - Country:US
Mailing Address - Phone:717-418-2877
Mailing Address - Fax:
Practice Address - Street 1:2208 CHATHAM WAY
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-3959
Practice Address - Country:US
Practice Address - Phone:717-418-2877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019271364SP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health