MEDICARE: MRS. VIVIAN T UZONWUNE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	SP020953	PA

General Provider Information

NPI Number	:	1578106795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VIVIAN T UZONWUNE

Provider Business Mailing Address
First Line	:	170 NORRISTOWN RD
Second Line	:
City	:	WARMINSTER
State	:	PA
Zip	:	18974-4075
Country	:	US
Telephone Number	:	267-265-5677
Fax Number	:

Provider Business Practice Location Address
First Line	:	11600 CAROLINE RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-2110
Country	:	US
Telephone Number	:	215-632-6400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2019
Last Update Date	:	05/20/2022

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