MEDICARE: MR. JOSEPH N NWUFOH

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	106S00000X	Behavior Technician
2	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1831650605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH N NWUFOH

Provider Business Mailing Address
First Line	:	1615 JACKSON ST
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71202-2029
Country	:	US
Telephone Number	:	318-512-2857
Fax Number	:

Provider Business Practice Location Address
First Line	:	1615 JACKSON ST
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71202-2029
Country	:	US
Telephone Number	:	318-512-2857
Fax Number	:	318-388-4961

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

Provider Enumeration Date	:	03/26/2019
Last Update Date	:	03/26/2019

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