Provider Demographics
NPI:1942191176
Name:UMUNNA, CHIZOM OKECHUKWU
Entity type:Individual
Prefix:
First Name:CHIZOM
Middle Name:OKECHUKWU
Last Name:UMUNNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5335 28TH AVE S APT 110
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-9062
Mailing Address - Country:US
Mailing Address - Phone:701-212-6332
Mailing Address - Fax:
Practice Address - Street 1:5335 28TH AVE S APT 110
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-9062
Practice Address - Country:US
Practice Address - Phone:701-212-6332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND149844376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide