Provider Demographics
NPI:1144426487
Name:NWOSU, CHINYERE MGBAHURU (DO)
Entity Type:Individual
Prefix:DR
First Name:CHINYERE
Middle Name:MGBAHURU
Last Name:NWOSU
Suffix:
Gender:F
Credentials:DO
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 33269
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85067-3269
Mailing Address - Country:US
Mailing Address - Phone:602-406-4786
Mailing Address - Fax:916-636-4358
Practice Address - Street 1:485 S DOBSON RD STE 201
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5604
Practice Address - Country:US
Practice Address - Phone:480-728-4981
Practice Address - Fax:480-728-4985
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-1812-14207R00000X, 207RG0100X
NY257660207RG0100X
AZ007127207RG0100X
ORDO185474207RG0100X
WI81169207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100238353Medicaid
NM38080087Medicaid