Provider Demographics
NPI:1205537065
Name:AHUMARAEZE, IKECHUKWU ALEX
Entity type:Individual
Prefix:
First Name:IKECHUKWU
Middle Name:ALEX
Last Name:AHUMARAEZE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5297 HILLGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1111
Mailing Address - Country:US
Mailing Address - Phone:937-242-1570
Mailing Address - Fax:
Practice Address - Street 1:5297 HILLGROVE AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1111
Practice Address - Country:US
Practice Address - Phone:937-242-1570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN179795164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse