Provider Demographics
NPI:1568736312
Name:ONYEKACHI, CONNIE C (PROVIDER)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:C
Last Name:ONYEKACHI
Suffix:
Gender:F
Credentials:PROVIDER
Other - Prefix:
Other - First Name:CONSTANCE
Other - Middle Name:CHICHI
Other - Last Name:UGOCHUKWU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1247 N COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:MASCOUTAH
Mailing Address - State:IL
Mailing Address - Zip Code:62258-2713
Mailing Address - Country:US
Mailing Address - Phone:832-600-2117
Mailing Address - Fax:
Practice Address - Street 1:1247 N COUNTY RD
Practice Address - Street 2:
Practice Address - City:MASCOUTAH
Practice Address - State:IL
Practice Address - Zip Code:62258-2713
Practice Address - Country:US
Practice Address - Phone:832-600-2117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-25
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041495849163WH0200X, 163WP0807X
TX171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No171W00000XOther Service ProvidersContractor