Provider Demographics
NPI:1013699172
Name:CHIWEMBU, TISUNGANE BLESSING (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:TISUNGANE
Middle Name:BLESSING
Last Name:CHIWEMBU
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 GRANDE OAK BLVD APT 1102
Mailing Address - Street 2:
Mailing Address - City:SARALAND
Mailing Address - State:AL
Mailing Address - Zip Code:36571-3741
Mailing Address - Country:US
Mailing Address - Phone:251-533-0642
Mailing Address - Fax:251-602-9146
Practice Address - Street 1:3151-A KNOLLWOOD DRIVE
Practice Address - Street 2:MOBILE, AL 36693
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36693
Practice Address - Country:US
Practice Address - Phone:251-661-7608
Practice Address - Fax:251-602-9146
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAG06230192363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology