MEDICARE: MCMAURICE C NDUBUEZE 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	372600000X	Adult Companion
2	374U00000X	Home Health Aide
3	376J00000X	Homemaker
4	163WH0200X	Home Health Registered Nurse	0001264587	VA

General Provider Information

NPI Number	:	1447758578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCMAURICE C NDUBUEZE RN

Provider Business Mailing Address
First Line	:	5215 COLLEY AVE STE 112
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23508-2166
Country	:	US
Telephone Number	:	757-321-0064
Fax Number	:

Provider Business Practice Location Address
First Line	:	5215 COLLEY AVE STE 112
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23508-2166
Country	:	US
Telephone Number	:	757-321-0064
Fax Number	:

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

Provider Enumeration Date	:	01/23/2018
Last Update Date	:	01/23/2018

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