1518706100 NPI number — BLESSING IJEOMA CHIEDOZIE PROMISE PMHNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518706100 NPI number — BLESSING IJEOMA CHIEDOZIE PROMISE PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHIEDOZIE PROMISE
Provider First Name:
BLESSING
Provider Middle Name:
IJEOMA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PMHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EZEIGBO
Provider Other First Name:
BLESSING
Provider Other Middle Name:
IJEOMA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518706100
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 CRAWFORD CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01108-3312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-234-5755
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26 CRAWFORD CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01108-3312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-234-5755
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  RN2331895 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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