Healthcare Provider Details

I. General information

NPI: 1689132292
Provider Name (Legal Business Name): JUDITH CHINONSO UWAZURUONYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 06/29/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 RED GRAVEL CIR
SICKLERVILLE NJ
08081-1672
US

IV. Provider business mailing address

14 RED GRAVEL CIR
SICKLERVILLE NJ
08081-1672
US

V. Phone/Fax

Practice location:
  • Phone: 856-418-0101
  • Fax:
Mailing address:
  • Phone: 856-264-6915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01435700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: