Healthcare Provider Details

I. General information

NPI: 1164870887
Provider Name (Legal Business Name): THERESA NWOKA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 RHODE ISLAND AVE NW
WASHINGTON DC
20001-4153
US

IV. Provider business mailing address

915 RHODE ISLAND AVE NW
WASHINGTON DC
20001-4153
US

V. Phone/Fax

Practice location:
  • Phone: 202-232-6100
  • Fax: 202-664-7069
Mailing address:
  • Phone: 202-232-6100
  • Fax: 202-664-7069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN 1002370
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: