Healthcare Provider Details

I. General information

NPI: 1518136910
Provider Name (Legal Business Name): IFEOMA F NWOYE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 GRANITE ST
HURLEY WI
54534-1372
US

IV. Provider business mailing address

N10565 GRANDVIEW LN
IRONWOOD MI
49938-9622
US

V. Phone/Fax

Practice location:
  • Phone: 715-561-2255
  • Fax: 715-561-5021
Mailing address:
  • Phone: 906-932-1500
  • Fax: 906-932-5630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number51319
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: