Provider Demographics
NPI:1679754733
Name:NWANNA, LINUS NNODI (NURSE)
Entity type:Individual
Prefix:
First Name:LINUS
Middle Name:NNODI
Last Name:NWANNA
Suffix:
Gender:M
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9898 BISSONNET ST
Mailing Address - Street 2:260
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8270
Mailing Address - Country:US
Mailing Address - Phone:713-981-7629
Mailing Address - Fax:713-981-0727
Practice Address - Street 1:9898 BISSONNET ST
Practice Address - Street 2:260
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8270
Practice Address - Country:US
Practice Address - Phone:713-981-7629
Practice Address - Fax:713-981-0727
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010301163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
673130Medicare Oscar/Certification