Provider Demographics
NPI:1629443742
Name:ONUOHA, CHUKWUDI U (RN)
Entity Type:Individual
Prefix:
First Name:CHUKWUDI
Middle Name:U
Last Name:ONUOHA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23935 OUTER DR APT D20
Mailing Address - Street 2:
Mailing Address - City:MELVINDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48122-1667
Mailing Address - Country:US
Mailing Address - Phone:313-850-2753
Mailing Address - Fax:
Practice Address - Street 1:18300 LAHSER RD
Practice Address - Street 2:APT B206
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-4324
Practice Address - Country:US
Practice Address - Phone:313-850-2753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703115678164W00000X
MI4704346654163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse