Provider Demographics
NPI:1265962591
Name:MBACHU, MARGARET ADA
Entity type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:ADA
Last Name:MBACHU
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARGARET
Other - Middle Name:ADA
Other - Last Name:CHIKEZIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:965 ALDERBROOK CT
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-2637
Mailing Address - Country:US
Mailing Address - Phone:219-323-9209
Mailing Address - Fax:219-663-6758
Practice Address - Street 1:14121 PARKE LONG CT
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1647
Practice Address - Country:US
Practice Address - Phone:212-323-9209
Practice Address - Fax:219-663-6758
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF1216566363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily