Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 19133 | NV |
N | 208000000X | Pediatrician | 2016-01484 | NC |
NPI | 1760772453 |
---|---|
Provider Name | Dr. Peace Nnenna Ibekwe |
First Address | Las Vegas, NV 89109-2317 |
Second Address | New York, NY 10037-1802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2011 |
Last Update Date | 06/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
207PP0204X | (05) | NV |