Healthcare Provider Details

I. General information

NPI: 1295177277
Provider Name (Legal Business Name): CLARA NNEBUOGOR UWAMU RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2013
Last Update Date: 06/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S MEDFORD DR
LUFKIN TX
75901-6260
US

IV. Provider business mailing address

2600 VICTORY PKWY CINCINNATI
CINCINNATI OH
45206-1711
US

V. Phone/Fax

Practice location:
  • Phone: 936-633-5672
  • Fax: 936-633-5695
Mailing address:
  • Phone: 513-751-7747
  • Fax: 513-751-0180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number843595
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.303331-COA1
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.14498-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: