Organization Name: | NWABUEZE NNAMDI INC |
NPI Number: | 1114047735 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | STACIE N NWABUEZE (ADMINISTRATOR) |
Mailing Address: | 3050 Charles Dr Jackson |
State: | LA US |
Postal Code: | 707486135 |
Phone Number: | 2256343517 |
Fax Number: | 2256355057 |
NPI Enumeration Date: | 03/29/2007 |
NPI Last Update Date: | 07/06/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | L12712R |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | LA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |