Healthcare Provider Details

I. General information

NPI: 1497098883
Provider Name (Legal Business Name): LEO IWE NWAOKWU FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LEO IWE NWAOKWU FNP

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GALISTEO ST
SANTA FE NM
87505-4747
US

IV. Provider business mailing address

18749 MARSH LN APT 213
DALLAS TX
75287-3506
US

V. Phone/Fax

Practice location:
  • Phone: 512-287-0444
  • Fax:
Mailing address:
  • Phone: 512-287-0444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07191726
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number60305
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number651848
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: