Provider Demographics
NPI:1740589068
Name:OKEKE, CHIZOBAM IFEOMA (RN, BSN, PHN)
Entity Type:Individual
Prefix:
First Name:CHIZOBAM
Middle Name:IFEOMA
Last Name:OKEKE
Suffix:
Gender:F
Credentials:RN, BSN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W OCEAN BLVD APT 6302
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-7956
Mailing Address - Country:US
Mailing Address - Phone:562-253-0671
Mailing Address - Fax:562-253-0671
Practice Address - Street 1:300 W OCEAN BLVD APT 6302
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-7956
Practice Address - Country:US
Practice Address - Phone:562-253-0671
Practice Address - Fax:562-253-0671
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA712195163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse