Healthcare Provider Details

I. General information

NPI: 1902561608
Provider Name (Legal Business Name): CARLINE IFEOMA UWAJEH DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 STONEBROOK PKWY
FRISCO TX
75034-5749
US

IV. Provider business mailing address

PO BOX 746079
ATLANTA GA
30374-6079
US

V. Phone/Fax

Practice location:
  • Phone: 972-377-6744
  • Fax:
Mailing address:
  • Phone: 312-733-9730
  • Fax: 773-866-8014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1069094
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number041459331
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1069094
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: