Healthcare Provider Details

I. General information

NPI: 1720296635
Provider Name (Legal Business Name): CHIATUOGU UKAGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 05/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 PAYNE AVE SUITE 200
SAINT PAUL MN
55130-3538
US

IV. Provider business mailing address

8814 PHEASANT RUN RD
WOODBURY MN
55125-8887
US

V. Phone/Fax

Practice location:
  • Phone: 651-209-8350
  • Fax: 651-209-8353
Mailing address:
  • Phone: 651-702-5631
  • Fax: 651-731-7616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR 143046-2
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: