MEDICARE: CHINYERE IZUCHUKWU NP

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	363LF0000X	Family Nurse Practitioner	AANP F1214038	GA

General Provider Information

NPI Number	:	1942698022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHINYERE IZUCHUKWU NP

Provider Business Mailing Address
First Line	:	2815 CAROLINA RDG
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30296-6021
Country	:	US
Telephone Number	:	770-907-9382
Fax Number	:

Provider Business Practice Location Address
First Line	:	2815 CAROLINA RDG
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30296-6021
Country	:	US
Telephone Number	:	770-907-9382
Fax Number	:

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

Provider Enumeration Date	:	12/25/2014
Last Update Date	:	11/23/2016

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