Provider Demographics
NPI:1548422215
Name:ICHOKU, NNEKA UDONNA (DO, MPH)
Entity Type:Individual
Prefix:DR
First Name:NNEKA
Middle Name:UDONNA
Last Name:ICHOKU
Suffix:
Gender:F
Credentials:DO, MPH
Other - Prefix:
Other - First Name:NNEKA
Other - Middle Name:UDONNA
Other - Last Name:EKUNNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1551 WALL ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-3539
Mailing Address - Country:US
Mailing Address - Phone:636-669-2268
Mailing Address - Fax:
Practice Address - Street 1:9759 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-1346
Practice Address - Country:US
Practice Address - Phone:314-781-4922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0030507207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2016016734OtherMO LICENSE