Provider Demographics
NPI:1336651520
Name:CHILAKA, OLUCHI (PMHNP- BC)
Entity Type:Individual
Prefix:
First Name:OLUCHI
Middle Name:
Last Name:CHILAKA
Suffix:
Gender:F
Credentials:PMHNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 WALDORF PL
Mailing Address - Street 2:
Mailing Address - City:VAUXHALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07088-1418
Mailing Address - Country:US
Mailing Address - Phone:908-922-1727
Mailing Address - Fax:
Practice Address - Street 1:50 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-1735
Practice Address - Country:US
Practice Address - Phone:973-625-7009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-29
Last Update Date:2017-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00763600363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health