Provider Demographics
NPI:1801589619
Name:CHUKADZE, ELMIRA (CNP)
Entity type:Individual
Prefix:
First Name:ELMIRA
Middle Name:
Last Name:CHUKADZE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 MILLHOFF DR
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-3158
Mailing Address - Country:US
Mailing Address - Phone:404-992-2133
Mailing Address - Fax:
Practice Address - Street 1:6520 MILLHOFF DR
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-3158
Practice Address - Country:US
Practice Address - Phone:404-992-2133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0033769363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily