MEDICARE: CHRISTIANA CHIOMA EGWIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	RN284402	MA

General Provider Information

NPI Number	:	1245535004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIANA CHIOMA EGWIM

Provider Business Mailing Address
First Line	:	1017 TURNPIKE ST STE 36B
Second Line	:
City	:	CANTON
State	:	MA
Zip	:	02021-2828
Country	:	US
Telephone Number	:	617-943-5606
Fax Number	:

Provider Business Practice Location Address
First Line	:	1017 TURNPIKE ST STE 36B
Second Line	:
City	:	CANTON
State	:	MA
Zip	:	02021-2828
Country	:	US
Telephone Number	:	617-943-5606
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2011
Last Update Date	:	09/17/2021

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