Provider Demographics
NPI:1922769124
Name:CHUKWU, NKEM CYNTHIA (QMHS)
Entity Type:Individual
Prefix:
First Name:NKEM
Middle Name:CYNTHIA
Last Name:CHUKWU
Suffix:
Gender:F
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 LINDEN AVENUE
Mailing Address - Street 2:SUITE 245
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432
Mailing Address - Country:US
Mailing Address - Phone:937-716-1791
Mailing Address - Fax:937-938-1729
Practice Address - Street 1:4130 LINDEN AVE STE 245
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-3049
Practice Address - Country:US
Practice Address - Phone:937-716-1791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHVJ936267OtherDRIVERS LICENSE