Provider Demographics
NPI:1740171123
Name:CHUDI-AGBAKU, DOROTHY OZOEMENAM
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:OZOEMENAM
Last Name:CHUDI-AGBAKU
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 1:214 W ALAMOS AVE APT 204B
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-3609
Mailing Address - Country:US
Mailing Address - Phone:859-279-8225
Mailing Address - Fax:
Practice Address - Street 1:214 W ALAMOS AVE APT 204B
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3609
Practice Address - Country:US
Practice Address - Phone:859-279-8225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95035973363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily