Provider Demographics
NPI:1700456951
Name:IFELE, OLUCHUKWU ANNE (APRN-CNP)
Entity type:Individual
Prefix:MRS
First Name:OLUCHUKWU
Middle Name:ANNE
Last Name:IFELE
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 HOMESTEAD ST APT 106
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57703-0209
Mailing Address - Country:US
Mailing Address - Phone:605-545-6000
Mailing Address - Fax:
Practice Address - Street 1:1023 MUIRFIELD DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6634
Practice Address - Country:US
Practice Address - Phone:605-545-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX940401163W00000X
TX1167873363LA2100X
SDR053081163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care