Provider Demographics
NPI:1508581174
Name:CHUKWUMA, PEACE CHIOMA (APRN)
Entity Type:Individual
Prefix:
First Name:PEACE
Middle Name:CHIOMA
Last Name:CHUKWUMA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:TRUTH OR CONSEQUENCES
Mailing Address - State:NM
Mailing Address - Zip Code:87901-1961
Mailing Address - Country:US
Mailing Address - Phone:575-894-3221
Mailing Address - Fax:575-894-4999
Practice Address - Street 1:800 E 9TH AVE
Practice Address - Street 2:
Practice Address - City:TRUTH OR CONSEQUENCES
Practice Address - State:NM
Practice Address - Zip Code:87901-1961
Practice Address - Country:US
Practice Address - Phone:575-894-3221
Practice Address - Fax:575-894-4999
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1070663363LP0808X
NM69960363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health