Provider Demographics
NPI:1215226246
Name:JUMBO, CHIKAODILI (NP)
Entity Type:Individual
Prefix:MISS
First Name:CHIKAODILI
Middle Name:
Last Name:JUMBO
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 1:1650 METROPOLITAN AVE
Mailing Address - Street 2:APT. 12C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-6980
Mailing Address - Country:US
Mailing Address - Phone:646-595-7246
Mailing Address - Fax:
Practice Address - Street 1:4645 SWEETWATER BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3016
Practice Address - Country:US
Practice Address - Phone:815-651-1122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1045490363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care