Healthcare Provider Details

I. General information

NPI: 1740788181
Provider Name (Legal Business Name): VINCENT NZENWA NKWO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 PARK RD NW APT C
WASHINGTON DC
20010-2560
US

IV. Provider business mailing address

621 PARK RD NW APT C
WASHINGTON DC
20010-2560
US

V. Phone/Fax

Practice location:
  • Phone: 202-766-7420
  • Fax:
Mailing address:
  • Phone: 202-766-7420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA13204
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA13204
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: