Healthcare Provider Details

I. General information

NPI: 1003182031
Provider Name (Legal Business Name): OLUEBERE CHINYERE NWOKOCHA REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2012
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 EDGECOMBE AVE
NEW YORK NY
10032-4349
US

IV. Provider business mailing address

3730 PRATT AVE FL 1
BRONX NY
10466-5929
US

V. Phone/Fax

Practice location:
  • Phone: 212-923-2575
  • Fax:
Mailing address:
  • Phone: 212-923-2575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF343533
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number520926
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: