Provider Demographics
NPI:1619206190
Name:OSUDOH, CHINWE LINDA (CNP)
Entity Type:Individual
Prefix:
First Name:CHINWE
Middle Name:LINDA
Last Name:OSUDOH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 N MAIN ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1179
Mailing Address - Country:US
Mailing Address - Phone:937-836-5171
Mailing Address - Fax:
Practice Address - Street 1:9000 N MAIN ST
Practice Address - Street 2:SUITE 403
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45415-1179
Practice Address - Country:US
Practice Address - Phone:937-836-5171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2015-12-02
Deactivation Date:2010-07-27
Deactivation Code:
Reactivation Date:2015-11-20
Provider Licenses
StateLicense IDTaxonomies
OHR.N. 353696163W00000X
OHCOA.17777-NP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse