Healthcare Provider Details

I. General information

NPI: 1023266830
Provider Name (Legal Business Name): MS. JULIANA I NWAOGU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 PAERDEGAT 1ST ST
BROOKLYN NY
11236-3839
US

IV. Provider business mailing address

68 PAERDEGAT 1ST ST
BROOKLYN NY
11236-3839
US

V. Phone/Fax

Practice location:
  • Phone: 718-251-4380
  • Fax:
Mailing address:
  • Phone: 718-251-4380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number457765
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number457765
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number457765
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: