Healthcare Provider Details

I. General information

NPI: 1376962027
Provider Name (Legal Business Name): UKEGBU BEN IROHA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR
CHAPEL HILL NC
27514-4220
US

IV. Provider business mailing address

11230 CENTWAY PARK DR APT 101
RALEIGH NC
27617-8476
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-4131
  • Fax:
Mailing address:
  • Phone: 803-614-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number102591
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: