Healthcare Provider Details

I. General information

NPI: 1396542676
Provider Name (Legal Business Name): CHIDINMA BLESSING OKWUEZE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 BOULEVARD
COLONIAL HEIGHTS VA
23834-1344
US

IV. Provider business mailing address

16713 LILTING MOON CT
MOSELEY VA
23120-2325
US

V. Phone/Fax

Practice location:
  • Phone: 804-547-9564
  • Fax:
Mailing address:
  • Phone: 804-504-6939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024192415
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: