Provider Demographics
NPI:1053961987
Name:NWANDU, MICHAEL (DNP)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:NWANDU
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 YORK RD STE 601
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6009
Mailing Address - Country:US
Mailing Address - Phone:443-442-4818
Mailing Address - Fax:
Practice Address - Street 1:1301 YORK RD STE 601
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6009
Practice Address - Country:US
Practice Address - Phone:443-442-4818
Practice Address - Fax:410-650-9053
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR133615363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health