Provider Demographics
NPI:1821408204
Name:IZEGBU, CHINWE MERCY
Entity Type:Individual
Prefix:
First Name:CHINWE
Middle Name:MERCY
Last Name:IZEGBU
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 1:4 LAYTHAN RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-4708
Mailing Address - Country:US
Mailing Address - Phone:732-423-8884
Mailing Address - Fax:732-287-6417
Practice Address - Street 1:4 SCHALKS CROSSING RD
Practice Address - Street 2:MINUTECLINIC
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-1604
Practice Address - Country:US
Practice Address - Phone:609-275-9312
Practice Address - Fax:609-936-1219
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00483800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily