MEDICARE: DR. EMA UKO-ABASI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	23783	TN
2	363LF0000X	Family Nurse Practitioner	RN2358169	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	23783	OTHER	TN	STATE LICENSE NUMBER
2	C-APN.0001216-C-NP	OTHER	CO	STATE LICENSE NUMBER
3	RN2358169	OTHER	MA	STATE LICENSE

General Provider Information

NPI Number	:	1245739341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMA UKO-ABASI

Provider Business Mailing Address
First Line	:	171 DWIGHT RD STE 102
Second Line	:
City	:	LONGMEADOW
State	:	MA
Zip	:	01106-1768
Country	:	US
Telephone Number	:	413-824-4070
Fax Number	:

Provider Business Practice Location Address
First Line	:	171 DWIGHT RD STE 102
Second Line	:
City	:	LONGMEADOW
State	:	MA
Zip	:	01106-1768
Country	:	US
Telephone Number	:	413-824-4070
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2018
Last Update Date	:	02/23/2023

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