Healthcare Provider Details

I. General information

NPI: 1417545443
Provider Name (Legal Business Name): THERESA CHINERO IWUNDU SR. NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 01/05/2021
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 NEWTON ST NE
WASHINGTON DC
20017-1763
US

IV. Provider business mailing address

1033 NEWTON ST NE
WASHINGTON DC
20017-1763
US

V. Phone/Fax

Practice location:
  • Phone: 202-569-4778
  • Fax:
Mailing address:
  • Phone: 202-569-4778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN1014369
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: