Provider Demographics
NPI:1962239095
Name:IHEBEREME, CHIOMA
Entity type:Individual
Prefix:
First Name:CHIOMA
Middle Name:
Last Name:IHEBEREME
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 LAKE SEYMOUR DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-4657
Mailing Address - Country:US
Mailing Address - Phone:240-486-6087
Mailing Address - Fax:
Practice Address - Street 1:51 DEAK DR
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1268
Practice Address - Country:US
Practice Address - Phone:302-653-1281
Practice Address - Fax:302-653-1268
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-13
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0012869363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty