Provider Demographics
NPI:1306619259
Name:EGWUONWU, CHINELLO (RN, CCM, NP)
Entity type:Individual
Prefix:
First Name:CHINELLO
Middle Name:
Last Name:EGWUONWU
Suffix:
Gender:F
Credentials:RN, CCM, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 NORWOOD ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1035
Mailing Address - Country:US
Mailing Address - Phone:510-712-9554
Mailing Address - Fax:
Practice Address - Street 1:515 NORWOOD ST UNIT 2
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1035
Practice Address - Country:US
Practice Address - Phone:510-712-9554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY557450-01163W00000X
NJ4206962163WC0400X
NJ26NJ15016100363LF0000X
NJ26NR17760800163W00000X
NYF348855-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase Management