Provider Demographics
NPI:1841986874
Name:MADU, OKECHUKWU ANSLEM (APN)
Entity type:Individual
Prefix:
First Name:OKECHUKWU
Middle Name:ANSLEM
Last Name:MADU
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 MONTICELLO DR
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-2309
Mailing Address - Country:US
Mailing Address - Phone:856-650-6509
Mailing Address - Fax:
Practice Address - Street 1:301 SPRING GARDEN RD # MAINF2
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-9699
Practice Address - Country:US
Practice Address - Phone:856-650-6509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01468400363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty