MEDICARE: LEO IWE NWAOKWU FNP

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	363LF0000X	Family Nurse Practitioner	F07191726	TX
2	363LF0000X	Family Nurse Practitioner	60305	NM
3	163WC1500X	Community Health Registered Nurse	651848	NY

General Provider Information

NPI Number	:	1497098883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEO IWE NWAOKWU FNP

Provider Business Mailing Address
First Line	:	18749 MARSH LN APT 213
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75287-3506
Country	:	US
Telephone Number	:	512-287-0444
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 GALISTEO ST
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-4747
Country	:	US
Telephone Number	:	512-287-0444
Fax Number	:

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

Provider Enumeration Date	:	04/03/2013
Last Update Date	:	01/27/2022

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