Provider Demographics
NPI:1528535465
Name:AGBO, CHIOMA EUNICE (PSYCH NP)
Entity Type:Individual
Prefix:
First Name:CHIOMA
Middle Name:EUNICE
Last Name:AGBO
Suffix:
Gender:F
Credentials:PSYCH NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 ANDREA DR
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-3705
Mailing Address - Country:US
Mailing Address - Phone:973-873-3083
Mailing Address - Fax:
Practice Address - Street 1:245 ANDREA DR
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-3705
Practice Address - Country:US
Practice Address - Phone:973-873-3083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00875300363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health