Provider Demographics
NPI:1245535004
Name:EGWIM, CHRISTIANA CHIOMA
Entity type:Individual
Prefix:
First Name:CHRISTIANA
Middle Name:CHIOMA
Last Name:EGWIM
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 1:1017 TURNPIKE ST STE 36B
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2828
Mailing Address - Country:US
Mailing Address - Phone:617-943-5606
Mailing Address - Fax:
Practice Address - Street 1:1017 TURNPIKE ST STE 36B
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2828
Practice Address - Country:US
Practice Address - Phone:617-943-5606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN284402363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care