Provider Demographics
NPI:1750772570
Name:CHIKA PATIENCE OKEREKW-NWANKWO
Entity type:Organization
Organization Name:CHIKA PATIENCE OKEREKW-NWANKWO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHIKA
Authorized Official - Middle Name:PATIENCE
Authorized Official - Last Name:OKEREKE-NWANKWO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:781-956-1866
Mailing Address - Street 1:22 MARION ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-2437
Mailing Address - Country:US
Mailing Address - Phone:781-956-1866
Mailing Address - Fax:
Practice Address - Street 1:22 MARION STREET
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368
Practice Address - Country:US
Practice Address - Phone:781-956-1866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN195244311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA021785698Medicaid