Provider Demographics
NPI:1871756973
Name:IKE, CHARLES CHUKWUDI (LPN)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:CHUKWUDI
Last Name:IKE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1291 PADDINGTON CT
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1736
Mailing Address - Country:US
Mailing Address - Phone:614-843-1343
Mailing Address - Fax:
Practice Address - Street 1:1291 PADDINGTON CT
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-1736
Practice Address - Country:US
Practice Address - Phone:614-843-1343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN117579-MEDS164W00000X
OHPN11579-MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse