Provider Demographics
NPI:1093176729
Name:OFOMA, CHINELO (NP)
Entity Type:Individual
Prefix:
First Name:CHINELO
Middle Name:
Last Name:OFOMA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 GOLD HILL RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-8906
Mailing Address - Country:US
Mailing Address - Phone:803-802-5900
Mailing Address - Fax:803-802-7101
Practice Address - Street 1:704 GOLD HILL RD
Practice Address - Street 2:SUITE 207
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-8906
Practice Address - Country:US
Practice Address - Phone:803-802-5900
Practice Address - Fax:803-802-7101
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00610800363LP0200X
SC20099363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3863Medicaid