Provider Demographics
NPI:1093313587
Name:CHUKWUMA, CATHERINE IFEOMA (NP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:IFEOMA
Last Name:CHUKWUMA
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 1:2521 SEMINARY AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-1307
Mailing Address - Country:US
Mailing Address - Phone:510-777-1000
Mailing Address - Fax:
Practice Address - Street 1:523 BANFF CT
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-6642
Practice Address - Country:US
Practice Address - Phone:925-918-2899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner