Provider Demographics
NPI:1952699613
Name:EKECHUKWU, OLUCHI
Entity Type:Individual
Prefix:
First Name:OLUCHI
Middle Name:
Last Name:EKECHUKWU
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 1:356 STUYVESANT AVE
Mailing Address - Street 2:APT 406
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111
Mailing Address - Country:US
Mailing Address - Phone:973-399-9938
Mailing Address - Fax:
Practice Address - Street 1:356 STUYVESANT AVE
Practice Address - Street 2:APT 406
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-1615
Practice Address - Country:US
Practice Address - Phone:973-399-9938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305209164W00000X
NJ26NP06625400164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY305209OtherLPN LICENSE