Provider Demographics
NPI:1861127136
Name:NWANKWO, CHIDIMMA
Entity type:Individual
Prefix:
First Name:CHIDIMMA
Middle Name:
Last Name:NWANKWO
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 1:2185 WILDWOOD MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-6634
Mailing Address - Country:US
Mailing Address - Phone:314-761-5456
Mailing Address - Fax:
Practice Address - Street 1:2185 WILDWOOD MEADOWS CT
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63005-6634
Practice Address - Country:US
Practice Address - Phone:314-761-5456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022012139363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care