MEDICARE: IKENNA DANIEL USONWU MSN FNP-BC

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	363LF0000X	Family Nurse Practitioner	26NJ00786500	NJ

General Provider Information

NPI Number	:	1881109627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IKENNA DANIEL USONWU MSN FNP-BC

Provider Business Mailing Address
First Line	:	1070 ROBIN RD
Second Line	:
City	:	HILLSBOROUGH
State	:	NJ
Zip	:	08844-4432
Country	:	US
Telephone Number	:	732-910-8673
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 KLOCKNER RD
Second Line	:
City	:	HAMILTON
State	:	NJ
Zip	:	08690-3417
Country	:	US
Telephone Number	:	609-587-2300
Fax Number	:

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

Provider Enumeration Date	:	12/01/2017
Last Update Date	:	12/01/2017

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