Healthcare Provider Details

I. General information

NPI: 1972234060
Provider Name (Legal Business Name): CHERYL U. UKEGBU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 BROADWAY
NEW YORK NY
10036-7329
US

IV. Provider business mailing address

222 SUMMIT AVE E APT 105
SEATTLE WA
98102-5658
US

V. Phone/Fax

Practice location:
  • Phone: 120-642-2536
  • Fax:
Mailing address:
  • Phone: 917-443-0633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR197151
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: