=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942191176
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHIZOM OKECHUKWU UMUNNA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2025
-----------------------------------------------------
Last Update Date | 07/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5335 28TH AVE S APT 110
-----------------------------------------------------
City | FARGO
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58104-9062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-212-6332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5335 28TH AVE S APT 110
-----------------------------------------------------
City | FARGO
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58104-9062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-212-6332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376K00000X
-----------------------------------------------------
Taxonomy Name | Nurse's Aide
-----------------------------------------------------
License Number | 149844
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------