Provider Demographics
NPI:1588708051
Name:NWOKOLO, CHINYELU NKEMDILIM (RN)
Entity type:Individual
Prefix:
First Name:CHINYELU
Middle Name:NKEMDILIM
Last Name:NWOKOLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8406 BENT MAPLE CT
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-9090
Mailing Address - Country:US
Mailing Address - Phone:614-856-1971
Mailing Address - Fax:
Practice Address - Street 1:8406 BENT MAPLE CT
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-9090
Practice Address - Country:US
Practice Address - Phone:614-856-1971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH299981163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2690011Medicaid