Provider Demographics
NPI:1033691431
Name:EJIM, CHINYERE PRINCESS
Entity Type:Individual
Prefix:
First Name:CHINYERE
Middle Name:PRINCESS
Last Name:EJIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 GRANITE PARK LN
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77469-2179
Mailing Address - Country:US
Mailing Address - Phone:936-244-2473
Mailing Address - Fax:
Practice Address - Street 1:2326 GRANITE PARK LN
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77469-2179
Practice Address - Country:US
Practice Address - Phone:936-244-2473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX827260163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse