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NPI Code Detail

MEDICARE: LARRY C IWEAJUNWA

MEDICARE: LARRY C IWEAJUNWA
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
1363LF0000XFamily Nurse Practitioner1057828TX

General Provider Information

NPI Number : 1518622562
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARRY C IWEAJUNWA
Provider Business Mailing Address
First Line : PO BOX 746079
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6079
Country : US
Telephone Number : 773-352-1515
Fax Number : 312-929-0373
Provider Business Practice Location Address
First Line : 11251 FONDREN RD
Second Line :
City : HOUSTON
State : TX
Zip : 77096-5507
Country : US
Telephone Number : 281-707-7362
Fax Number : 832-827-8503
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2021
Last Update Date : 06/05/2026

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Directions to “ LARRY C IWEAJUNWA ” Practice Location

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