Provider Demographics
NPI:1326295114
Name:CHUKWU, IFEYINWA MARY
Entity Type:Individual
Prefix:
First Name:IFEYINWA
Middle Name:MARY
Last Name:CHUKWU
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 1:3536 HULL AVE
Mailing Address - Street 2:APT 2C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-1617
Mailing Address - Country:US
Mailing Address - Phone:347-275-7691
Mailing Address - Fax:
Practice Address - Street 1:3536 HULL AVE
Practice Address - Street 2:APT 2C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1617
Practice Address - Country:US
Practice Address - Phone:347-275-7691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293978-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse