MEDICARE: MRS. ELIZABETH NWABUEBO ANP

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	163W00000X	Registered Nurse	RN152992 NP	GA

General Provider Information

NPI Number	:	1962742726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH NWABUEBO ANP

Provider Business Mailing Address
First Line	:	415 BARRINGTON PT
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31220-8754
Country	:	US
Telephone Number	:	478-405-8061
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 BARRINGTON PT
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31220-8754
Country	:	US
Telephone Number	:	478-405-8061
Fax Number	:

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

Provider Enumeration Date	:	02/15/2013
Last Update Date	:	02/15/2013

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