Provider Demographics
NPI:1639608086
Name:FAVOR HEALTHCARE PRACTICE LLC
Entity Type:Organization
Organization Name:FAVOR HEALTHCARE PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IHUOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUKS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-NP-C
Authorized Official - Phone:302-363-5769
Mailing Address - Street 1:200 S DUPONT BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-1552
Mailing Address - Country:US
Mailing Address - Phone:302-423-0568
Mailing Address - Fax:
Practice Address - Street 1:200 S DUPONT BLVD STE 104
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1552
Practice Address - Country:US
Practice Address - Phone:302-423-0568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
DEL10024346363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1235417247OtherNPI TYPE 1