Healthcare Provider Details

I. General information

NPI: 1386955037
Provider Name (Legal Business Name): CHIDIMMA UCHE ABANULO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHIDIMMA UCHE ETO MD

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 07/27/2024
Certification Date: 07/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5289 NE ELAM YOUNG PKWY STE 150
HILLSBORO OR
97124-7551
US

IV. Provider business mailing address

14852 NW DEERFOOT LN
PORTLAND OR
97229-1552
US

V. Phone/Fax

Practice location:
  • Phone: 971-353-4925
  • Fax: 971-353-4926
Mailing address:
  • Phone: 404-394-0493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD187711
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberMD187711
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: