Healthcare Provider Details

I. General information

NPI: 1356987358
Provider Name (Legal Business Name): OFONMBUK UKOENINN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N HIGH POINT RD
MADISON WI
53717-1849
US

IV. Provider business mailing address

401 N HIGH POINT RD
MADISON WI
53717-1849
US

V. Phone/Fax

Practice location:
  • Phone: 573-999-0916
  • Fax: 608-821-0577
Mailing address:
  • Phone: 573-999-0916
  • Fax: 608-821-0577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number151614
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: