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Individual

CHIOMA STELLA GOODLUCK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
NURSE PRACTITIONER

Contact information

Practice address
4217 GUNTHER AVE, BRONX, NY 10466-2007
(646) 382-1886
Mailing address
4217 GUNTHER AVE, BRONX, NY 10466-2007
(646) 382-1886

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
737620-01
NY
363L00000X
Nurse Practitioner
F353448-01
NY
363LF0000X
Family Nurse Practitioner
F353448-01
NY

Other

Enumeration date
12/07/2023
Last updated
07/30/2024
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