Healthcare Provider Details

I. General information

NPI: 1962997205
Provider Name (Legal Business Name): CHINELO NKOLIKA NZEGWU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 SEAVIEW AVE
STATEN ISLAND NY
10305-3409
US

IV. Provider business mailing address

777 SEAVIEW AVE
STATEN ISLAND NY
10305-3409
US

V. Phone/Fax

Practice location:
  • Phone: 718-667-2591
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number613642
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: