Healthcare Provider Details

I. General information

NPI: 1154568566
Provider Name (Legal Business Name): CHINEDU JESSE AKAEZE RN, FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5465 BRIARDALE LN APT C APT C
DUBLIN OH
43016-5265
US

IV. Provider business mailing address

5465 BRIARDALE LN APT. C
DUBLIN OH
43016-5265
US

V. Phone/Fax

Practice location:
  • Phone: 614-553-7017
  • Fax:
Mailing address:
  • Phone: 614-553-7017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 356661-1
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number400696841207
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA 18172-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: