Healthcare Provider Details

I. General information

NPI: 1942916796
Provider Name (Legal Business Name): NWAKANMA VIVIAN NWADIKE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NWAKANMA V NWADIKE APN

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 HAMBURG TPKE
WAYNE NJ
07470-4032
US

IV. Provider business mailing address

1308 BRIGHT ST
HILLSIDE NJ
07205-2374
US

V. Phone/Fax

Practice location:
  • Phone: 908-526-8370
  • Fax:
Mailing address:
  • Phone: 973-978-2319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01366300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: