Healthcare Provider Details

I. General information

NPI: 1093811937
Provider Name (Legal Business Name): CHINELO J OKONKWO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 BREMO RD RICHMOND COMMUNITY EMERGENCY ASSOCIATES INC
RICHMOND VA
23226-1907
US

IV. Provider business mailing address

3519 IVYRIDGE DR
CHESTER VA
23831-4953
US

V. Phone/Fax

Practice location:
  • Phone: 804-287-7066
  • Fax: 804-673-9531
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0110002236
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: