1639461395 NPI number — DR. DANA CHANELLE UGWU M.D., MPH

Table of content: DR. DANA CHANELLE UGWU M.D., MPH (NPI 1639461395)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639461395 NPI number — DR. DANA CHANELLE UGWU M.D., MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UGWU
Provider First Name:
DANA
Provider Middle Name:
CHANELLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., MPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROLLERSON
Provider Other First Name:
DANA
Provider Other Middle Name:
CHANELLE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D., MPH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639461395
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5300 N INDEPENDENCE AVE STE 280
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73112-5555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-844-4300
Provider Business Mailing Address Fax Number:
405-844-4366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 RENAISSANCE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDMOND
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73013-3022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-844-4300
Provider Business Practice Location Address Fax Number:
405-844-4366
Provider Enumeration Date:
05/12/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  35536 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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