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General NPI Number Information
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NPI Number | 1861606451
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Entity Type | Individual
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Provider Name | NGOZI NWAMAKA MBAH M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 01/31/2014
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Provider Practice Location Address
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Address Line | 2641 DEVELOPMENT DRIVE
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City | GREEN BAY
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State | WI
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Zip | 54311
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Country | US
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Telephone | 920-338-6868
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Fax | 920-338-6859
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Provider Business Mailing Address
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Address Line | 2641 DEVELOPMENT DR
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City | GREEN BAY
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State | WI
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Zip | 54311-4240
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Country | US
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Telephone | 920-338-6868
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Fax | 920-338-6859
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MT189119
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License Number State | WI
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