MEDICARE: TOBBY N UZODINMA PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	10051935	OR

General Provider Information

NPI Number	:	1376410985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOBBY N UZODINMA PMHNP

Provider Business Mailing Address
First Line	:	2434 W 64TH AVE
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-2864
Country	:	US
Telephone Number	:	360-393-5820
Fax Number	:

Provider Business Practice Location Address
First Line	:	5737 NE 37TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-7905
Country	:	US
Telephone Number	:	253-922-4027
Fax Number	:

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

Provider Enumeration Date	:	10/20/2025
Last Update Date	:	10/21/2025

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