Provider Demographics
NPI:1477168755
Name:NNOLIM, CHIOMA FRANCES
Entity type:Individual
Prefix:DR
First Name:CHIOMA
Middle Name:FRANCES
Last Name:NNOLIM
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 1:12480 ABERDEEN ST NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-4721
Mailing Address - Country:US
Mailing Address - Phone:763-862-6596
Mailing Address - Fax:763-862-6928
Practice Address - Street 1:12480 ABERDEEN ST NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-4721
Practice Address - Country:US
Practice Address - Phone:763-862-6596
Practice Address - Fax:763-862-6928
Is Sole Proprietor?:No
Enumeration Date:2020-09-13
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN123053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist