MEDICARE: CHINYERE OBIAKWATA NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	26NJ00740100	NJ
2	363LP2300X	Primary Care Nurse Practitioner	AP137635	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043732555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHINYERE OBIAKWATA NP

Provider Business Mailing Address
First Line	:	201 PRUITT RD APT 430
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77380-3167
Country	:	US
Telephone Number	:	973-640-0074
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 PRUITT RD APT 430
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77380
Country	:	US
Telephone Number	:	973-640-0074
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2017
Last Update Date	:	03/06/2019

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Directions to “ CHINYERE OBIAKWATA NP” Practice Location

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