Provider Demographics
NPI:1700456951
Name:IFELE, OLUCHUKWU ANNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:OLUCHUKWU
Middle Name:ANNE
Last Name:IFELE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 HOMESTEAD ST APT 106
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57703-0209
Mailing Address - Country:US
Mailing Address - Phone:605-545-6000
Mailing Address - Fax:
Practice Address - Street 1:4909 HOMESTEAD ST APT 106
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57703-0209
Practice Address - Country:US
Practice Address - Phone:605-545-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD-RNR053081163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical