Healthcare Provider Details

I. General information

NPI: 1497744627
Provider Name (Legal Business Name): CHINYELU CHIOMA ONYEDIKE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 STERNBERG AVE SUITE 315,USAMEDDAC BLDG
FORT EUSTIS VA
23604-1526
US

IV. Provider business mailing address

576 JEFFERSON AVE
FORT EUSTIS VA
23604-1373
US

V. Phone/Fax

Practice location:
  • Phone: 757-314-4350
  • Fax:
Mailing address:
  • Phone: 757-314-7629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024164046
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: