Provider Demographics
NPI:1780179366
Name:OKWUFULUEZE, CHIKA CYNTHIA
Entity Type:Individual
Prefix:
First Name:CHIKA
Middle Name:CYNTHIA
Last Name:OKWUFULUEZE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10512 N 110TH EAST AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-6636
Mailing Address - Country:US
Mailing Address - Phone:918-376-8149
Mailing Address - Fax:918-376-8410
Practice Address - Street 1:10512 N 110TH EAST AVE STE 130
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-6636
Practice Address - Country:US
Practice Address - Phone:918-376-8149
Practice Address - Fax:918-376-8410
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK87560363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily