Provider Demographics
NPI:1063237832
Name:IGWEOBI, LUKE CHIKE
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:CHIKE
Last Name:IGWEOBI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 SCHOOL ST STE 1C
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-3153
Mailing Address - Country:US
Mailing Address - Phone:508-510-3333
Mailing Address - Fax:
Practice Address - Street 1:140 SCHOOL ST STE 1C
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3153
Practice Address - Country:US
Practice Address - Phone:508-510-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2310296363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health