Provider Demographics
NPI:1942922406
Name:IBEABUCHI, CHIAMAKA F (APRN)
Entity Type:Individual
Prefix:
First Name:CHIAMAKA
Middle Name:F
Last Name:IBEABUCHI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2466 AMATRICE ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044-1632
Mailing Address - Country:US
Mailing Address - Phone:619-565-7108
Mailing Address - Fax:
Practice Address - Street 1:2466 AMATRICE ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89044-1632
Practice Address - Country:US
Practice Address - Phone:619-565-7108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV858440364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health