Provider Demographics
NPI:1649792201
Name:IFEZUE, CHUKWUNONSO HARRISON
Entity type:Individual
Prefix:
First Name:CHUKWUNONSO
Middle Name:HARRISON
Last Name:IFEZUE
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 1:20102 BROOKWOOD HOLW
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-4005
Mailing Address - Country:US
Mailing Address - Phone:832-272-9414
Mailing Address - Fax:
Practice Address - Street 1:20102 BROOKWOOD HOLLOW
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407
Practice Address - Country:US
Practice Address - Phone:832-272-9414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health