Provider Demographics
NPI:1851855845
Name:MBAMAH, CHINYERE MERCY (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CHINYERE
Middle Name:MERCY
Last Name:MBAMAH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28110 ROLLCREST RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-4018
Mailing Address - Country:US
Mailing Address - Phone:248-579-3051
Mailing Address - Fax:
Practice Address - Street 1:24111 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2841
Practice Address - Country:US
Practice Address - Phone:248-557-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704197641363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care