Provider Demographics
NPI:1982176020
Name:CHUKWUDIKE, CHINWENDU JENNIFER (APRN)
Entity Type:Individual
Prefix:
First Name:CHINWENDU
Middle Name:JENNIFER
Last Name:CHUKWUDIKE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 FAIRE HARBOUR PL
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4710
Mailing Address - Country:US
Mailing Address - Phone:860-437-6914
Mailing Address - Fax:860-437-6920
Practice Address - Street 1:41 FAIRE HARBOUR PL
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4710
Practice Address - Country:US
Practice Address - Phone:860-437-6914
Practice Address - Fax:860-437-6920
Is Sole Proprietor?:No
Enumeration Date:2018-12-31
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8112363LF0000X
RIAPRN03579363LF0000X
CTAPRN8112363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
2023129435OtherANCC