MEDICARE: MR. SUNNY NNAMDI NGWU RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse	800977	TX

General Provider Information

NPI Number	:	1366285819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SUNNY NNAMDI NGWU RN

Provider Business Mailing Address
First Line	:	2306 ALASSIO ISLE CT
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-6976
Country	:	US
Telephone Number	:	443-626-7073
Fax Number	:

Provider Business Practice Location Address
First Line	:	2306 ALASSIO ISLE CT
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-6976
Country	:	US
Telephone Number	:	443-626-7073
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2024
Last Update Date	:	06/13/2024

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