Provider Demographics
NPI:1174705511
Name:ONIANWAH, NNEKA A (PA)
Entity type:Individual
Prefix:
First Name:NNEKA
Middle Name:A
Last Name:ONIANWAH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 W GREENWOOD AVE
Mailing Address - Street 2:2 ND FLOOR
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-1926
Mailing Address - Country:US
Mailing Address - Phone:610-394-2118
Mailing Address - Fax:
Practice Address - Street 1:2501 W LEHIGH AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19132-3207
Practice Address - Country:US
Practice Address - Phone:215-227-0300
Practice Address - Fax:215-227-0302
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051790363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA119496VEMMedicare PIN