Healthcare Provider Details

I. General information

NPI: 1336771799
Provider Name (Legal Business Name): CYNTHIA NNENNA UKE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. CYNTHIA NNENNA UKE

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 TRAWOOD DR
EL PASO TX
79936-4168
US

IV. Provider business mailing address

1908 POINTE LN E
EL PASO TX
79936-4025
US

V. Phone/Fax

Practice location:
  • Phone: 915-599-6735
  • Fax: 915-629-7627
Mailing address:
  • Phone: 915-487-9584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number941569
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1121924
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: