Healthcare Provider Details

I. General information

NPI: 1134805898
Provider Name (Legal Business Name): UCHECHI ONYEBUCHI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 LAFAYETTE ST
NEW BRITAIN CT
06051-1803
US

IV. Provider business mailing address

575 MAIN ST FL 2
MIDDLETOWN CT
06457-2845
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-3642
  • Fax:
Mailing address:
  • Phone: 860-347-6971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12214
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number186022
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: