Healthcare Provider Details

I. General information

NPI: 1750951653
Provider Name (Legal Business Name): NGOZI IHUNANYACHI NNODIM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NGOZI IHUNANYACHI NNODIM

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6452 WAYMORE LN APT 103
CHESTER VA
23831-3769
US

IV. Provider business mailing address

6452 WAYMORE LN APT 103
CHESTER VA
23831-3769
US

V. Phone/Fax

Practice location:
  • Phone: 804-432-4092
  • Fax:
Mailing address:
  • Phone: 804-432-4092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024179953
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: