Provider Demographics
NPI:1609514645
Name:OKONKWO, CHIBUIKE SAMUEL (RN)
Entity Type:Individual
Prefix:
First Name:CHIBUIKE
Middle Name:SAMUEL
Last Name:OKONKWO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1710 KNOLLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-0347
Mailing Address - Country:US
Mailing Address - Phone:678-200-8693
Mailing Address - Fax:
Practice Address - Street 1:1710 KNOLLWOOD RD
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-0347
Practice Address - Country:US
Practice Address - Phone:678-200-8693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX918557163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse