Provider Demographics
NPI:1043464837
Name:IGWEZE, CHIAGOZIEM (RN)
Entity Type:Individual
Prefix:
First Name:CHIAGOZIEM
Middle Name:
Last Name:IGWEZE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11669 GAYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-1107
Mailing Address - Country:US
Mailing Address - Phone:562-903-0683
Mailing Address - Fax:
Practice Address - Street 1:11669 GAYVIEW DR
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1107
Practice Address - Country:US
Practice Address - Phone:562-903-0683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA646768163W00000X
CA21458363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse