Healthcare Provider Details

I. General information

NPI: 1942706122
Provider Name (Legal Business Name): CHIOMA NWUGWO KEM NPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 VESTAL PKWY E STE 2W
VESTAL NY
13850-1966
US

IV. Provider business mailing address

2332 ACORN DR
VESTAL NY
13850-2604
US

V. Phone/Fax

Practice location:
  • Phone: 607-341-4950
  • Fax: 607-341-4933
Mailing address:
  • Phone: 607-240-9708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number406921
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number699524
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: