Provider Demographics
NPI:1114252798
Name:NGUMA, CHIDIMMA I (NP)
Entity Type:Individual
Prefix:MRS
First Name:CHIDIMMA
Middle Name:I
Last Name:NGUMA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:CHIDIMMA
Other - Middle Name:I
Other - Last Name:AZORO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:P.O. BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-645-4673
Mailing Address - Fax:972-669-7194
Practice Address - Street 1:5323 HARRY HINES BOULEVARD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:214-645-4673
Practice Address - Fax:972-669-7194
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305110363LA2200X
NYF340722-1363LG0600X
TXAP127629363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology