Healthcare Provider Details

I. General information

NPI: 1891294161
Provider Name (Legal Business Name): NNEKA OKOH GODWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 02/23/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 FOREST HILLS DR NE
ALBUQUERQUE NM
87109-4129
US

IV. Provider business mailing address

PO BOX 42738
TOWSON MD
21284-2738
US

V. Phone/Fax

Practice location:
  • Phone: 505-822-6000
  • Fax:
Mailing address:
  • Phone: 610-925-1032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP136385
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number62480
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: