Healthcare Provider Details

I. General information

NPI: 1063144673
Provider Name (Legal Business Name): NWANA MICHAEL NJIWAJI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7857 RIVERDALE RD APT 203
NEW CARROLLTON MD
20784-4027
US

IV. Provider business mailing address

7857 RIVERDALE RD APT 203
NEW CARROLLTON MD
20784-4027
US

V. Phone/Fax

Practice location:
  • Phone: 240-610-7204
  • Fax:
Mailing address:
  • Phone: 240-610-7204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200001929
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: