Provider Demographics
NPI:1568234284
Name:IBEAWUCHI, OLUCHI EZINWA
Entity Type:Individual
Prefix:
First Name:OLUCHI
Middle Name:EZINWA
Last Name:IBEAWUCHI
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 1:669 MILLERS MARK AVE
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-7059
Mailing Address - Country:US
Mailing Address - Phone:919-349-2509
Mailing Address - Fax:
Practice Address - Street 1:669 MILLERS MARK AVE
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-7059
Practice Address - Country:US
Practice Address - Phone:919-349-2509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care