Provider Demographics
NPI:1679955744
Name:NWACHUKWU, GERTRUDE O
Entity type:Individual
Prefix:
First Name:GERTRUDE
Middle Name:O
Last Name:NWACHUKWU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GETRUDE
Other - Middle Name:
Other - Last Name:NWACHUKWU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:505 SILVER SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4645
Mailing Address - Country:US
Mailing Address - Phone:202-246-1977
Mailing Address - Fax:
Practice Address - Street 1:10400 NAGLEE RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-1117
Practice Address - Country:US
Practice Address - Phone:240-853-4298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN67013163W00000X
MDR136706363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCRN67013Medicare UPIN