Basic Information
Provider Information | |||||||||
NPI: | 1285878744 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CHIKWA | ||||||||
FirstName: | NANCY | ||||||||
MiddleName: | IRENE | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | ACNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SULLIVAN | ||||||||
OtherFirstName: | NANCY | ||||||||
OtherMiddleName: | IRENE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | CNP | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 636256 | ||||||||
Address2: | CENTRAL CREDENTIALING | ||||||||
City: | CINCINNATI | ||||||||
State: | OH | ||||||||
PostalCode: | 452636256 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5132453104 | ||||||||
FaxNumber: | 5135855511 | ||||||||
Practice Location | |||||||||
Address1: | 7675 WELLNESS WAY | ||||||||
Address2: | STE 202 | ||||||||
City: | WEST CHESTER | ||||||||
State: | OH | ||||||||
PostalCode: | 450692509 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5134758523 | ||||||||
FaxNumber: | 5134757327 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/28/2009 | ||||||||
LastUpdateDate: | 08/18/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SA2100X | RN3013812 | OH | N |   | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Acute Care | 363LA2100X | COA.10626 | OH | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
ID | Type | State | Issuer | Description | 2983777 | 05 | OH |   | MEDICAID |