Healthcare Provider Details

I. General information

NPI: 1548036387
Provider Name (Legal Business Name): UCHE K OBU PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 FRANKLIN ST
WRENTHAM MA
02093-1232
US

IV. Provider business mailing address

895 FRANKLIN ST
WRENTHAM MA
02093-1232
US

V. Phone/Fax

Practice location:
  • Phone: 617-372-0925
  • Fax:
Mailing address:
  • Phone: 617-372-0925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2269345
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: