MEDICARE: MRS. BIBIANA CHIDIMMA ULUMENFO PMHNP, BSN, RN

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	163W00000X	Registered Nurse	0000110445	TN
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APN0000030932	TN

General Provider Information

NPI Number	:	1871123588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BIBIANA CHIDIMMA ULUMENFO PMHNP, BSN, RN

Provider Business Mailing Address
First Line	:	917 BLUE MOUNTAIN LN
Second Line	:
City	:	ANTIOCH
State	:	TN
Zip	:	37013-1785
Country	:	US
Telephone Number	:	615-586-8701
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 INTERNATIONAL PLZ
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37217-2017
Country	:	US
Telephone Number	:	615-367-8824
Fax Number	:

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

Provider Enumeration Date	:	01/22/2020
Last Update Date	:	09/08/2023

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