Healthcare Provider Details

I. General information

NPI: 1871170324
Provider Name (Legal Business Name): NKIRUKA CHIKA MGBEMENA MSN, RN.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 03/29/2021
Certification Date: 03/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 LYONS AVE
NEWARK NJ
07112-2027
US

IV. Provider business mailing address

90B NEWARK WAY
MAPLEWOOD NJ
07040-3312
US

V. Phone/Fax

Practice location:
  • Phone: 862-241-9314
  • Fax:
Mailing address:
  • Phone: 201-669-8035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NO11950200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: