MEDICARE: MRS. PRISCILLA I NWACHUKWU NP

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	194268	MA

General Provider Information

NPI Number	:	1982872651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PRISCILLA I NWACHUKWU NP

Provider Business Mailing Address
First Line	:	200 TRAPELO RD
Second Line	:
City	:	WALTHAM
State	:	MA
Zip	:	02452-6332
Country	:	US
Telephone Number	:	781-894-3600
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 TRAPELO RD
Second Line	:
City	:	WALTHAM
State	:	MA
Zip	:	02452-6332
Country	:	US
Telephone Number	:	781-894-3600
Fax Number	:

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

Provider Enumeration Date	:	02/15/2008
Last Update Date	:	02/15/2008

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