Provider Demographics
NPI:1356721468
Name:NWUFOH, JACQULINE
Entity type:Individual
Prefix:
First Name:JACQULINE
Middle Name:
Last Name:NWUFOH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 ALBERT ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5003
Mailing Address - Country:US
Mailing Address - Phone:318-512-2857
Mailing Address - Fax:318-324-9647
Practice Address - Street 1:1610 JACKSON ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-2030
Practice Address - Country:US
Practice Address - Phone:318-512-2857
Practice Address - Fax:318-324-9647
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator