Provider Demographics
NPI:1013354919
Name:NEBO, CHINYERE A (MS-FNP, RN)
Entity Type:Individual
Prefix:MRS
First Name:CHINYERE
Middle Name:A
Last Name:NEBO
Suffix:
Gender:F
Credentials:MS-FNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 E 175TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-5804
Mailing Address - Country:US
Mailing Address - Phone:347-600-5654
Mailing Address - Fax:347-600-5654
Practice Address - Street 1:170 EAST NEW YORK AVE.
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580
Practice Address - Country:US
Practice Address - Phone:347-600-5654
Practice Address - Fax:516-612-3871
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY649810163WG0000X
NY340108363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice