MEDICARE: MARY NNEKA UKPABI-EGBUNIWE FNP

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	0024171023	VA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024171023	VA

General Provider Information

NPI Number	:	1679848006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY NNEKA UKPABI-EGBUNIWE FNP

Provider Business Mailing Address
First Line	:	PO BOX 220
Second Line	:
City	:	NEW CANTON
State	:	VA
Zip	:	23123-0220
Country	:	US
Telephone Number	:	434-581-3271
Fax Number	:	434-581-1704

Provider Business Practice Location Address
First Line	:	4260 CROSSINGS BLVD
Second Line	:	SUITE 2
City	:	PRINCE GEORGE
State	:	VA
Zip	:	23875-1400
Country	:	US
Telephone Number	:	804-452-5800
Fax Number	:	804-452-5801

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

Provider Enumeration Date	:	03/19/2012
Last Update Date	:	02/07/2024

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