Healthcare Provider Details

I. General information

NPI: 1023575750
Provider Name (Legal Business Name): LUCIANA F NWOZOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2019
Last Update Date: 03/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 MILLWHEEL CT
LYNCHBURG VA
24503-3530
US

IV. Provider business mailing address

403 MILLWHEEL CT
LYNCHBURG VA
24503-3530
US

V. Phone/Fax

Practice location:
  • Phone: 434-258-0508
  • Fax:
Mailing address:
  • Phone: 434-258-0508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number1401184164
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: