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General NPI Number Information
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NPI Number | 1255769832
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Entity Type | Individual
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Provider Name | MARTIN IBEAWUCHI
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Gender | Male
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Dates
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Enumeration Date | 10/17/2013
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Last Update Date | 10/17/2013
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Provider Practice Location Address
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Address Line | 13 BLACK HORSE PIKE APT 2B
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City | HADDON HEIGHTS
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State | NJ
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Zip | 08035-1042
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Country | US
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Telephone | 863-835-0107
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Fax |
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Provider Business Mailing Address
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Address Line | 13 BLACK HORSE PIKE APT 2B
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City | HADDON HEIGHTS
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State | NJ
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Zip | 08035-1042
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Country | US
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Telephone | 863-835-0107
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 844821
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License Number State | TX
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