Active NPI
Christiana Nkwachi Nwaolu, NURSE PRACTITIONER
- Licensed Practical Nurse
- Fredericksburg, VA
National Provider Identifier
1407379068
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 0024175098
- Practice address
- 12225 Amos LN Ste 101
Fredericksburg, VA 22407-7108 - Phone
- (540) 755-7911
- Fax
- (540) 755-7903
- NPI assigned
- Jul 25, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 0024175098 | VA | Primary |
Addresses
Primary practice location
12225 Amos LN Ste 101
Fredericksburg, VA 22407-7108
Mailing address
4722 Gainsborough Dr
Fairfax, VA 22032-2379
Phone (703) 978-1869
Other practice location 1
12255 Fair Lakes Pkwy
Fairfax, VA 22033-3952
Phone (703) 359-7415
Other practice location 2
9811 Mallard Dr
Laurel, MD 20708-3143
Phone (301) 477-2684
Other practice location 3
12225 Amos Ln
Fredericksburg, VA 22407-7108
Phone (540) 755-7911
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0024175098 | VA | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550707200000",
"number": "1407379068",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4722 GAINSBOROUGH DR",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220322379",
"telephone_number": "703-978-1869"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12225 AMOS LN STE 101",
"city": "FREDERICKSBURG",
"state": "VA",
"postal_code": "224077108",
"telephone_number": "540-755-7911",
"fax_number": "540-755-7903"
}
],
"practiceLocations": [
{
"address_1": "12255 Fair Lakes Pkwy",
"address_purpose": "LOCATION",
"city": "Fairfax",
"state": "VA",
"postal_code": "220333952",
"country_code": "US",
"telephone_number": "703-359-7415",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "9811 Mallard Dr",
"address_purpose": "LOCATION",
"city": "Laurel",
"state": "MD",
"postal_code": "207083143",
"country_code": "US",
"telephone_number": "301-477-2684",
"fax_number": "301-477-3097",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "12225 Amos Ln",
"address_purpose": "LOCATION",
"city": "Fredericksburg",
"state": "VA",
"postal_code": "224077108",
"country_code": "US",
"telephone_number": "540-755-7911",
"fax_number": "540-755-7903",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NWAOLU",
"first_name": "CHRISTIANA",
"middle_name": "NKWACHI",
"credential": "NURSE PRACTITIONER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-07-25",
"last_updated": "2019-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "VA",
"license": "0024175098",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fredericksburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.