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NPI Code Detail

MEDICARE: MRS. DAWN DEBORRAH UKPONG RNFA

MEDICARE: MRS. DAWN DEBORRAH UKPONG RNFA
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
1163WR0006XRegistered Nurse First AssistantRN110507LA

General Provider Information

NPI Number : 1710004759
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DAWN DEBORRAH UKPONG RNFA
Provider Business Mailing Address
First Line : PO BOX 45319
Second Line :
City : BATON ROUGE
State : LA
Zip : 70895-4319
Country : US
Telephone Number : 225-505-3225
Fax Number : 225-926-0935
Provider Business Practice Location Address
First Line : 8508 GREENWELL SPRINGS RD
Second Line : APT 209
City : BATON ROUGE
State : LA
Zip : 70814-2425
Country : US
Telephone Number : 225-505-3225
Fax Number : 225-926-0935
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2007
Last Update Date : 07/08/2007

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