Healthcare Provider Details

I. General information

NPI: 1366786048
Provider Name (Legal Business Name): COLLINS O UZUEGBU CNS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 KOLBE RD
LORAIN OH
44053-1632
US

IV. Provider business mailing address

3500 KOLBE RD
LORAIN OH
44053-1632
US

V. Phone/Fax

Practice location:
  • Phone: 440-934-1458
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number2012012832
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: