Healthcare Provider Details

I. General information

NPI: 1104178987
Provider Name (Legal Business Name): ROSE AMAKA NWADILI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10213 SEA PINES DRIVE
BOWIE MD
20721
US

IV. Provider business mailing address

10213 SEA PINES DRIVE
BOWIE MD
20721
US

V. Phone/Fax

Practice location:
  • Phone: 202-547-2949
  • Fax:
Mailing address:
  • Phone: 202-547-2949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN62978
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: