Healthcare Provider Details

I. General information

NPI: 1164528907
Provider Name (Legal Business Name): UKAMAKA MARIAN ORUCHE MSN, RN, CS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1434 SHELBY ST
INDIANAPOLIS IN
46203-1945
US

IV. Provider business mailing address

9785 VALLEY SPRINGS BLVD
FISHERS IN
46037-8764
US

V. Phone/Fax

Practice location:
  • Phone: 317-655-3218
  • Fax: 317-931-5140
Mailing address:
  • Phone: 317-913-6755
  • Fax: 317-453-3393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number70000070
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: