Healthcare Provider Details

I. General information

NPI: 1508389768
Provider Name (Legal Business Name): HENRIETTA C. NWANKWO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 KATIE LN
MADISON WI
53704-8951
US

IV. Provider business mailing address

5425 KATIE LN
MADISON WI
53704-8951
US

V. Phone/Fax

Practice location:
  • Phone: 608-444-3813
  • Fax:
Mailing address:
  • Phone: 608-444-3813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number154052-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: