Provider Demographics
NPI:1144626987
Name:ILO, CHIUZO (AGPCNP)
Entity type:Individual
Prefix:
First Name:CHIUZO
Middle Name:
Last Name:ILO
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:CHIBUZO
Other - Middle Name:
Other - Last Name:ILO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AGPCNP
Mailing Address - Street 1:110 DUNLOP VLG
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-1764
Mailing Address - Country:US
Mailing Address - Phone:804-526-6062
Mailing Address - Fax:
Practice Address - Street 1:110 DUNLOP VLG
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1764
Practice Address - Country:US
Practice Address - Phone:804-526-6062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171972363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology