Provider Demographics
NPI:1629613161
Name:CHIMEZIE, IKENNA CYRIL (LPN)
Entity Type:Individual
Prefix:MR
First Name:IKENNA
Middle Name:CYRIL
Last Name:CHIMEZIE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 CANVAS BACK CIR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-1535
Mailing Address - Country:US
Mailing Address - Phone:513-406-8717
Mailing Address - Fax:
Practice Address - Street 1:501 CANVAS BACK CIR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-1535
Practice Address - Country:US
Practice Address - Phone:513-406-8717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH125139164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty