Healthcare Provider Details

I. General information

NPI: 1487955944
Provider Name (Legal Business Name): CHINYERE JULIA IGBOELI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2010
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR ST TMP 3
NEW HAVEN CT
06510-3206
US

IV. Provider business mailing address

333 CEDAR ST P.O. BOX 208051
NEW HAVEN CT
06510-3206
US

V. Phone/Fax

Practice location:
  • Phone: 203-737-1549
  • Fax: 203-785-6664
Mailing address:
  • Phone: 203-737-1549
  • Fax: 203-785-6664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number096404
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4631
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: