Provider Demographics
NPI:1467923243
Name:AMADI, CHINENYE
Entity Type:Individual
Prefix:MS
First Name:CHINENYE
Middle Name:
Last Name:AMADI
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 1:1350 HIGH SITE DR APT 218
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-2153
Mailing Address - Country:US
Mailing Address - Phone:651-278-0737
Mailing Address - Fax:
Practice Address - Street 1:1350 HIGH SITE DR APT 218
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-2153
Practice Address - Country:US
Practice Address - Phone:651-278-0737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN818821164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse