Provider Demographics
NPI:1235830142
Name:NWANEBU, CHINWEMMA
Entity Type:Individual
Prefix:
First Name:CHINWEMMA
Middle Name:
Last Name:NWANEBU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6804 NW 135TH CIR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-5922
Mailing Address - Country:US
Mailing Address - Phone:405-821-3057
Mailing Address - Fax:
Practice Address - Street 1:10802 QUAIL PLAZA DR STE 208
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-3121
Practice Address - Country:US
Practice Address - Phone:405-889-3571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11361101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional