Healthcare Provider Details

I. General information

NPI: 1811700180
Provider Name (Legal Business Name): CHIKODILI CATHERINE UBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6428 S 23RD AVE
PHOENIX AZ
85041-5357
US

IV. Provider business mailing address

21289 S 187TH WAY
QUEEN CREEK AZ
85142-3668
US

V. Phone/Fax

Practice location:
  • Phone: 832-513-5993
  • Fax:
Mailing address:
  • Phone: 832-513-5993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number896103
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: