Healthcare Provider Details

I. General information

NPI: 1063291615
Provider Name (Legal Business Name): PROMISE URUONYEAKU UKACHU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 E ST SE
WASHINGTON DC
20003-2593
US

IV. Provider business mailing address

1905 E ST SE
WASHINGTON DC
20003-2593
US

V. Phone/Fax

Practice location:
  • Phone: 202-673-9321
  • Fax:
Mailing address:
  • Phone: 301-747-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN1053124
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: