Healthcare Provider Details

I. General information

NPI: 1376216473
Provider Name (Legal Business Name): VALENTINE NWANNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 28TH ST SE
WASHINGTON DC
20020-3602
US

IV. Provider business mailing address

8031 IANS ALY
LAUREL MD
20724-6134
US

V. Phone/Fax

Practice location:
  • Phone: 240-716-1626
  • Fax:
Mailing address:
  • Phone: 240-714-1626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: