Provider Demographics
NPI:1053785634
Name:IBEKWE-NWONUMAH, CHINWEM A
Entity type:Individual
Prefix:
First Name:CHINWEM
Middle Name:A
Last Name:IBEKWE-NWONUMAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7205 WIND ELM CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-3877
Mailing Address - Country:US
Mailing Address - Phone:469-585-7331
Mailing Address - Fax:
Practice Address - Street 1:7205 WIND ELM CT
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-3877
Practice Address - Country:US
Practice Address - Phone:469-585-7331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-19
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX736312163W00000X
TX73AP136355363LF0000X
TXAP136355363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse