Provider Demographics
NPI:1942698022
Name:IZUCHUKWU, CHINYERE (NP)
Entity Type:Individual
Prefix:
First Name:CHINYERE
Middle Name:
Last Name:IZUCHUKWU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 CAROLINA RDG
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-6021
Mailing Address - Country:US
Mailing Address - Phone:770-907-9382
Mailing Address - Fax:
Practice Address - Street 1:2815 CAROLINA RDG
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-6021
Practice Address - Country:US
Practice Address - Phone:770-907-9382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-25
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAANP F1214038363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily