Provider Demographics
NPI:1912485475
Name:EMEKA NWONOVO, CHINELO CLEMENTINA (MD)
Entity Type:Individual
Prefix:
First Name:CHINELO
Middle Name:CLEMENTINA
Last Name:EMEKA NWONOVO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 W JACKSON BLVD UNIT G
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-5303
Mailing Address - Country:US
Mailing Address - Phone:916-701-0024
Mailing Address - Fax:
Practice Address - Street 1:7815 CHARMETTE WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5101
Practice Address - Country:US
Practice Address - Phone:916-701-0024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.078337207R00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine