Healthcare Provider Details

I. General information

NPI: 1609428390
Provider Name (Legal Business Name): NUBIA NJIEKO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8208 REYNOLDSWOOD DR
REYNOLDSBURG OH
43068-9333
US

IV. Provider business mailing address

8208 REYNOLDSWOOD DR # A
REYNOLDSBURG OH
43068-9333
US

V. Phone/Fax

Practice location:
  • Phone: 240-723-4665
  • Fax:
Mailing address:
  • Phone: 240-723-4665
  • Fax: 240-723-4665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN170223
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: