Provider Demographics
NPI:1578607784
Name:ENWOROM, CHINYERE DIVINELOVE (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:CHINYERE
Middle Name:DIVINELOVE
Last Name:ENWOROM
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 VALLA CRUCIS LN
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7059
Mailing Address - Country:US
Mailing Address - Phone:770-963-9363
Mailing Address - Fax:
Practice Address - Street 1:605 OLD NORCROSS RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-4315
Practice Address - Country:US
Practice Address - Phone:770-962-1231
Practice Address - Fax:770-513-2107
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN180187 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily