Provider Demographics
NPI:1770745184
Name:NDUBISI, CHINWE N (APRN, CRNP-F, PHD)
Entity type:Individual
Prefix:
First Name:CHINWE
Middle Name:N
Last Name:NDUBISI
Suffix:
Gender:F
Credentials:APRN, CRNP-F, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MERCANTILE LN
Mailing Address - Street 2:SUITE 124
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5341
Mailing Address - Country:US
Mailing Address - Phone:301-322-9292
Mailing Address - Fax:310-322-9555
Practice Address - Street 1:1400 MERCANTILE LN
Practice Address - Street 2:SUITE 124
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5341
Practice Address - Country:US
Practice Address - Phone:301-237-7383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN56166363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily