MEDICARE: CHRISTIAN C. NGWU RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	639230	NY

General Provider Information

NPI Number	:	1154682383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN C. NGWU RN

Provider Business Mailing Address
First Line	:	485 BAY ST
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14609-4608
Country	:	US
Telephone Number	:	585-360-9397
Fax Number	:

Provider Business Practice Location Address
First Line	:	485 BAY ST
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14609-4608
Country	:	US
Telephone Number	:	585-360-9397
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2012
Last Update Date	:	06/05/2012

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