Provider Demographics
NPI:1083587349
Name:CHUKWU, CHINWEOTITO LAURA
Entity type:Individual
Prefix:
First Name:CHINWEOTITO
Middle Name:LAURA
Last Name:CHUKWU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHINWEOTITO
Other - Middle Name:LAURA
Other - Last Name:NWACHUKWU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2924 W OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-2774
Mailing Address - Country:US
Mailing Address - Phone:610-812-6256
Mailing Address - Fax:
Practice Address - Street 1:2924 W OXFORD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-2774
Practice Address - Country:US
Practice Address - Phone:610-812-6256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN719924163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse