Provider Demographics
NPI:1083489835
Name:EGERUO, ISRAEL CHIKA
Entity Type:Individual
Prefix:
First Name:ISRAEL
Middle Name:CHIKA
Last Name:EGERUO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WESTFIELD ST # 1
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-3432
Mailing Address - Country:US
Mailing Address - Phone:857-417-2367
Mailing Address - Fax:
Practice Address - Street 1:16 WESTFIELD ST # 1
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-3432
Practice Address - Country:US
Practice Address - Phone:857-417-2367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2351079363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health