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General NPI Number Information
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NPI Number | 1063237832
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Entity Type | Individual
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Provider Name | LUKE CHIKE IGWEOBI
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Gender | Male
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 140 SCHOOL ST STE 1C
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City | BROCKTON
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State | MA
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Zip | 02302-3153
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Country | US
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Telephone | 508-510-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 140 SCHOOL ST STE 1C
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City | BROCKTON
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State | MA
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Zip | 02302-3153
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Country | US
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Telephone | 508-510-3333
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN2310296
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License Number State | MA
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