Provider Demographics
NPI:1184356370
Name:CHUKWU-DURU, LORETA NGOZI
Entity type:Individual
Prefix:
First Name:LORETA
Middle Name:NGOZI
Last Name:CHUKWU-DURU
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 1:3535 LAUREL BAY LOOP
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-1120
Mailing Address - Country:US
Mailing Address - Phone:512-663-7573
Mailing Address - Fax:
Practice Address - Street 1:3535 LAUREL BAY LOOP
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-1120
Practice Address - Country:US
Practice Address - Phone:512-663-7573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX721533313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX721533OtherNURSING