Provider Demographics
NPI:1174595060
Name:NWANKUDU, ADA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:ADA
Middle Name:
Last Name:NWANKUDU
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:NWADA
Other - Middle Name:OGBONNA
Other - Last Name:NWANKUDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:401 KEISLER DRIVE STE.100
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518
Mailing Address - Country:US
Mailing Address - Phone:919-439-6120
Mailing Address - Fax:919-246-4420
Practice Address - Street 1:401 KEISLER DR STE 100
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518
Practice Address - Country:US
Practice Address - Phone:919-439-6120
Practice Address - Fax:919-246-4420
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2148363LP2300X
NC5011639363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ56965Medicare UPIN