Healthcare Provider Details

I. General information

NPI: 1538851928
Provider Name (Legal Business Name): MS. CHINWENDU C NZEREM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 WASHINGTON ST
DORCHESTER MA
02124-3510
US

IV. Provider business mailing address

750 BEECHMONT ST
HYDE PARK MA
02136-1327
US

V. Phone/Fax

Practice location:
  • Phone: 617-825-9660
  • Fax: 617-822-8216
Mailing address:
  • Phone: 857-364-8746
  • Fax: 617-822-8216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN250613
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN250613
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License NumberRN250613
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: