Healthcare Provider Details

I. General information

NPI: 1285878744
Provider Name (Legal Business Name): NANCY IRENE CHIKWA ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY IRENE SULLIVAN CNP

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 08/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7675 WELLNESS WAY STE 202
WEST CHESTER OH
45069-2509
US

IV. Provider business mailing address

PO BOX 636256 CENTRAL CREDENTIALING
CINCINNATI OH
45263-6256
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8523
  • Fax: 513-475-7327
Mailing address:
  • Phone: 513-245-3104
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCOA.10626
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License NumberRN3013812
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: