Provider Demographics
NPI:1891384053
Name:IGWE, CHIMEZIE LEONA
Entity Type:Individual
Prefix:
First Name:CHIMEZIE
Middle Name:LEONA
Last Name:IGWE
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 1:12462 SPLIT REIN DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-2414
Mailing Address - Country:US
Mailing Address - Phone:951-333-3171
Mailing Address - Fax:
Practice Address - Street 1:12462 SPLIT REIN DR
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-2414
Practice Address - Country:US
Practice Address - Phone:951-333-3171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016231363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health