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NPI Code Detail

MEDICARE: CHINYERE DIVINELOVE ENWOROM MSN, APRN, FNP-BC

MEDICARE: CHINYERE DIVINELOVE ENWOROM MSN, APRN, FNP-BC
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
1363LF0000XFamily Nurse PractitionerRN180187 NPGA

General Provider Information

NPI Number : 1578607784
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHINYERE DIVINELOVE ENWOROM MSN, APRN, FNP-BC
Provider Business Mailing Address
First Line : 730 VALLA CRUCIS LN
Second Line :
City : DACULA
State : GA
Zip : 30019-7059
Country : US
Telephone Number : 770-963-9363
Fax Number :
Provider Business Practice Location Address
First Line : 605 OLD NORCROSS RD
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30045-4315
Country : US
Telephone Number : 770-962-1231
Fax Number : 770-513-2107
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2007
Last Update Date : 09/19/2011

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