MEDICARE: DR. JEROME NWANNA NWOKIKE M.D.

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	2084F0202X	Forensic Psychiatry Physician	D0059285	MD
2	2084P0800X	Psychiatry Physician	D0059285	MD
3	2084P0804X	Child & Adolescent Psychiatry Physician	D0059285	MD

General Provider Information

NPI Number	:	1346225794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEROME NWANNA NWOKIKE M.D.

Provider Business Mailing Address
First Line	:	P.O.BOX 371531
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89137
Country	:	US
Telephone Number	:	702-750-2438
Fax Number	:	702-750-2173

Provider Business Practice Location Address
First Line	:	5105 CAMINO AL NORTE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2373
Country	:	US
Telephone Number	:	702-750-2438
Fax Number	:	702-750-2173

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

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	07/10/2014

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