Healthcare Provider Details

I. General information

NPI: 1962295386
Provider Name (Legal Business Name): CHINONSO OKEKE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 MCDANIEL RD APT 13302
DULUTH GA
30096-8663
US

IV. Provider business mailing address

3355 MCDANIEL RD APT 13302
DULUTH GA
30096-8663
US

V. Phone/Fax

Practice location:
  • Phone: 570-605-9498
  • Fax:
Mailing address:
  • Phone: 570-605-9498
  • Fax: 570-605-9498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN283711
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN283711
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN283711
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: