Provider Demographics
NPI:1376888610
Name:IHENACHOR, PAMELA NGOZI (PA-C)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:NGOZI
Last Name:IHENACHOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 EAST DELAWARE PLACE
Mailing Address - Street 2:APT 802
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4254
Mailing Address - Country:US
Mailing Address - Phone:301-640-6651
Mailing Address - Fax:
Practice Address - Street 1:211 EAST DELAWARE PLACE
Practice Address - Street 2:APT 802
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4254
Practice Address - Country:US
Practice Address - Phone:301-640-6651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004527363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant