Healthcare Provider Details

I. General information

NPI: 1073245510
Provider Name (Legal Business Name): CHIOMA IKEDINOBI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 WELLESLEY ST
WESTON MA
02493-1572
US

IV. Provider business mailing address

1401 WOODPECKER LN
MANSFIELD TX
76063-6511
US

V. Phone/Fax

Practice location:
  • Phone: 325-301-9857
  • Fax:
Mailing address:
  • Phone: 325-301-9857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1195980
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: