Provider Demographics
NPI:1700906732
Name:NDUBUAKU, CHIOMA MERCY
Entity Type:Individual
Prefix:MS
First Name:CHIOMA
Middle Name:MERCY
Last Name:NDUBUAKU
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 1:7175 RUE DE MARGOT DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-3717
Mailing Address - Country:US
Mailing Address - Phone:317-295-8574
Mailing Address - Fax:
Practice Address - Street 1:7175 RUE DE MARGOT DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-3717
Practice Address - Country:US
Practice Address - Phone:317-295-8574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN48-03-04-00305376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN48-03-04-00305OtherHHA REGISTRATION