Provider Demographics
NPI:1538762430
Name:NWAEBIEM, UMEZULIKE DADA
Entity type:Individual
Prefix:MR
First Name:UMEZULIKE
Middle Name:DADA
Last Name:NWAEBIEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 KING WILLIAM RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1802
Mailing Address - Country:US
Mailing Address - Phone:919-931-5167
Mailing Address - Fax:
Practice Address - Street 1:112 KING WILLIAM RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1802
Practice Address - Country:US
Practice Address - Phone:919-931-5167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC5392253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care