Provider Demographics
NPI:1073157210
Name:NCHOTU, SUCCESS NGWASIRI (PA)
Entity Type:Individual
Prefix:
First Name:SUCCESS
Middle Name:NGWASIRI
Last Name:NCHOTU
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-2417
Mailing Address - Country:US
Mailing Address - Phone:757-325-7598
Mailing Address - Fax:
Practice Address - Street 1:4212 PARK PLACE CT
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3314
Practice Address - Country:US
Practice Address - Phone:804-315-3135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program