Healthcare Provider Details

I. General information

NPI: 1467814541
Provider Name (Legal Business Name): CHIDINMA ENWERE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 MAIN ST
CHARLESTOWN MA
02129-1125
US

IV. Provider business mailing address

41 AUBURN ST
HAVERHILL MA
01830-5003
US

V. Phone/Fax

Practice location:
  • Phone: 617-426-0600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2265205
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: