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General NPI Number Information
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NPI Number | 1578607784
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Entity Type | Individual
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Provider Name | CHINYERE DIVINELOVE ENWOROM MSN, APRN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 09/19/2011
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Provider Practice Location Address
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Address Line | 605 OLD NORCROSS RD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-4315
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Country | US
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Telephone | 770-962-1231
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Fax | 770-513-2107
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Provider Business Mailing Address
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Address Line | 730 VALLA CRUCIS LN
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City | DACULA
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State | GA
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Zip | 30019-7059
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Country | US
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Telephone | 770-963-9363
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN180187 NP
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License Number State | GA
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