MEDICARE: CHIKA NWOLISA CRNP

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	363LA2200X	Adult Health Nurse Practitioner	R164648	MD

General Provider Information

NPI Number	:	1922309756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHIKA NWOLISA CRNP

Provider Business Mailing Address
First Line	:	13012 SILVER MAPLE CT
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20715-1932
Country	:	US
Telephone Number	:	301-758-7587
Fax Number	:

Provider Business Practice Location Address
First Line	:	13012 SILVER MAPLE CT
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20715-1932
Country	:	US
Telephone Number	:	301-758-7587
Fax Number	:

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

Provider Enumeration Date	:	11/10/2010
Last Update Date	:	11/10/2010

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