Provider Demographics
NPI:1275174807
Name:ILOABACHIE, CHIOMA E (NP)
Entity Type:Individual
Prefix:
First Name:CHIOMA
Middle Name:E
Last Name:ILOABACHIE
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 1:4705 DRESDEN VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-4983
Mailing Address - Country:US
Mailing Address - Phone:919-749-2693
Mailing Address - Fax:
Practice Address - Street 1:319 N GRAHAM HOPEDALE RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2990
Practice Address - Country:US
Practice Address - Phone:336-570-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCAG04190024363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health