Provider Demographics
NPI:1235704222
Name:ONWUEGBUCHU, CHIDIMMA A (FNP-C)
Entity Type:Individual
Prefix:
First Name:CHIDIMMA
Middle Name:A
Last Name:ONWUEGBUCHU
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11748 HEATHERWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-4188
Mailing Address - Country:US
Mailing Address - Phone:313-377-3940
Mailing Address - Fax:
Practice Address - Street 1:8500 14TH ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-2574
Practice Address - Country:US
Practice Address - Phone:313-377-3940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-23
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704297557163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice