Provider Demographics
NPI:1588101570
Name:IHECHUKWU, OBIANUJU (NP)
Entity type:Individual
Prefix:MRS
First Name:OBIANUJU
Middle Name:
Last Name:IHECHUKWU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 BOWSTRING WAY
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-6455
Mailing Address - Country:US
Mailing Address - Phone:781-354-1359
Mailing Address - Fax:
Practice Address - Street 1:225 MAYNARD RD
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-2505
Practice Address - Country:US
Practice Address - Phone:781-354-1359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2023-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAG10220055363L00000X
MARN277627163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse