Provider Demographics
NPI:1578007233
Name:MIRIKWE, CHINWE CHINELO (FNP)
Entity Type:Individual
Prefix:
First Name:CHINWE
Middle Name:CHINELO
Last Name:MIRIKWE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-1712
Mailing Address - Country:US
Mailing Address - Phone:252-793-1619
Mailing Address - Fax:252-793-1644
Practice Address - Street 1:210 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-1712
Practice Address - Country:US
Practice Address - Phone:252-793-1619
Practice Address - Fax:252-793-1644
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF0916189363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1194706671Medicare NSC