Provider Demographics
NPI:1134797228
Name:CHIKEZIE, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:CHIKEZIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8957 EDMONSTON RD STE P
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-4048
Mailing Address - Country:US
Mailing Address - Phone:240-476-9409
Mailing Address - Fax:
Practice Address - Street 1:8957 EDMONSTON RD STE P
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-4048
Practice Address - Country:US
Practice Address - Phone:609-225-1255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR144177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily