Healthcare Provider Details

I. General information

NPI: 1801472311
Provider Name (Legal Business Name): DAVID EFEROGHENE UKPOKPO MSN, APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 READ ST
ATTLEBORO MA
02703-6161
US

IV. Provider business mailing address

410 READ ST
ATTLEBORO MA
02703-6161
US

V. Phone/Fax

Practice location:
  • Phone: 617-792-7612
  • Fax:
Mailing address:
  • Phone: 617-792-7612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRN23142N
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: