Healthcare Provider Details

I. General information

NPI: 1477263416
Provider Name (Legal Business Name): ESSIEN UKPE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3348 POE AVE
CLOVIS CA
93619-5018
US

IV. Provider business mailing address

3348 POE AVE
CLOVIS CA
93619-5018
US

V. Phone/Fax

Practice location:
  • Phone: 559-371-0826
  • Fax:
Mailing address:
  • Phone: 559-371-0826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number747271
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: