Healthcare Provider Details

I. General information

NPI: 1548422199
Provider Name (Legal Business Name): NKIRUKA I NWEBUBE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST
DAYTON OH
45409-2722
US

IV. Provider business mailing address

4991 LAKE BROOK DR SUITE 300
GLEN ALLEN VA
23060-9290
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-2912
  • Fax: 937-208-4515
Mailing address:
  • Phone: 888-627-4702
  • Fax: 804-253-0408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number35.091486
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: