Provider Demographics
NPI:1073215083
Name:NDLOVU, CHIPO (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CHIPO
Middle Name:
Last Name:NDLOVU
Suffix:
Gender:F
Credentials:PMHNP-BC
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 4796
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-4796
Mailing Address - Country:US
Mailing Address - Phone:956-570-5110
Mailing Address - Fax:956-679-3040
Practice Address - Street 1:5415 N MCCOLL RD STE 105
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4664
Practice Address - Country:US
Practice Address - Phone:956-570-5110
Practice Address - Fax:956-679-3040
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111337363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2W2675OtherMEDICARE