Provider Demographics
NPI:1972486348
Name:MADUABUM, NWANNEDIMMA ONYEKACHI
Entity type:Individual
Prefix:
First Name:NWANNEDIMMA
Middle Name:ONYEKACHI
Last Name:MADUABUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4277 PELICAN ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9735
Mailing Address - Country:US
Mailing Address - Phone:682-582-5846
Mailing Address - Fax:
Practice Address - Street 1:802 E CENTER ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-4402
Practice Address - Country:US
Practice Address - Phone:336-746-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20461225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist