Provider Demographics
NPI:1073124004
Name:CHIMA-NLEWEM, CHINEME (PA-C)
Entity Type:Individual
Prefix:
First Name:CHINEME
Middle Name:
Last Name:CHIMA-NLEWEM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2129
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760-2129
Mailing Address - Country:US
Mailing Address - Phone:432-640-3774
Mailing Address - Fax:432-640-4774
Practice Address - Street 1:500 N WASHINGTON AVE STE 400
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4437
Practice Address - Country:US
Practice Address - Phone:432-640-3774
Practice Address - Fax:432-640-4774
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXPA16124363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program