Healthcare Provider Details

I. General information

NPI: 1477018257
Provider Name (Legal Business Name): UCHENNA KACHI KANU RN725919
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 E 31ST ST
OAKLAND CA
94602-1092
US

IV. Provider business mailing address

1411 E 31ST ST
OAKLAND CA
94602-1092
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-8563
  • Fax: 510-437-8369
Mailing address:
  • Phone: 510-437-8563
  • Fax: 510-437-8369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN725919
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: