Provider Demographics
NPI:1063309953
Name:CHIGBUNDU, PRINCE JOEL
Entity type:Individual
Prefix:
First Name:PRINCE
Middle Name:JOEL
Last Name:CHIGBUNDU
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 1:4060 VINTON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-3863
Mailing Address - Country:US
Mailing Address - Phone:402-503-3175
Mailing Address - Fax:
Practice Address - Street 1:6120 N 78TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-2100
Practice Address - Country:US
Practice Address - Phone:402-378-4454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE164440374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide