Provider Demographics
NPI:1235875162
Name:IKE, AUGUSTINA CHIDINMA (APN)
Entity Type:Individual
Prefix:MRS
First Name:AUGUSTINA
Middle Name:CHIDINMA
Last Name:IKE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 EDWARD TER
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5106
Mailing Address - Country:US
Mailing Address - Phone:201-790-4587
Mailing Address - Fax:
Practice Address - Street 1:1710 EDWARD TER
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5106
Practice Address - Country:US
Practice Address - Phone:201-790-4587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01306400363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health