Provider Demographics
NPI:1679067615
Name:CHUKWU, MARCEL IKENNA (NP)
Entity Type:Individual
Prefix:
First Name:MARCEL
Middle Name:IKENNA
Last Name:CHUKWU
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9234 N LOOP 1604 W STE 107
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2981
Mailing Address - Country:US
Mailing Address - Phone:210-963-7398
Mailing Address - Fax:210-963-8512
Practice Address - Street 1:9234 N LOOP 1604 W STE 107
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2981
Practice Address - Country:US
Practice Address - Phone:210-963-7398
Practice Address - Fax:210-963-8512
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily