Provider Demographics
NPI:1326589391
Name:AJAERE, CHIDIEBERE (FNP)
Entity Type:Individual
Prefix:
First Name:CHIDIEBERE
Middle Name:
Last Name:AJAERE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:CHIDIEBERE
Other - Middle Name:
Other - Last Name:AJAERE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:675 LINCOLN AVE APT 12U
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-4027
Mailing Address - Country:US
Mailing Address - Phone:917-251-7337
Mailing Address - Fax:
Practice Address - Street 1:675 LINCOLN AVE APT 12U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-4027
Practice Address - Country:US
Practice Address - Phone:917-251-7337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF341021363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner