Healthcare Provider Details

I. General information

NPI: 1225282379
Provider Name (Legal Business Name): JOHN NKENCHO NWAEZEAPU CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 13TH ST NW
WASHINGTON DC
20012-2904
US

IV. Provider business mailing address

6500 13TH ST NW
WASHINGTON DC
20012-2904
US

V. Phone/Fax

Practice location:
  • Phone: 202-726-0420
  • Fax:
Mailing address:
  • Phone: 202-726-0420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR129485
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN63042
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: