Healthcare Provider Details

I. General information

NPI: 1508697392
Provider Name (Legal Business Name): UGONNA EJINDU PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

371 NE GILMAN BLVD STE 160
ISSAQUAH WA
98027-2901
US

IV. Provider business mailing address

307 N UNIVERSITY BLVD
MOBILE AL
36688-3053
US

V. Phone/Fax

Practice location:
  • Phone: 615-601-0857
  • Fax:
Mailing address:
  • Phone: 870-316-1832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number36057
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberL8-0010646
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP70016697
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: