Provider Demographics
NPI:1497364459
Name:GUBOR, CHIDINMA IFECHUKWU (DNP,APRN,PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CHIDINMA
Middle Name:IFECHUKWU
Last Name:GUBOR
Suffix:
Gender:F
Credentials:DNP,APRN,PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 LEVERICH DR
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-1432
Mailing Address - Country:US
Mailing Address - Phone:203-843-2264
Mailing Address - Fax:
Practice Address - Street 1:270 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-3516
Practice Address - Country:US
Practice Address - Phone:203-843-2264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2025-09-01
Deactivation Date:2021-04-04
Deactivation Code:
Reactivation Date:2021-05-18
Provider Licenses
StateLicense IDTaxonomies
CT9369363LP0808X
RIAPRN04440363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health