1679848006 NPI number — MARY NNEKA UKPABI-EGBUNIWE FNP

Table of content: MARY NNEKA UKPABI-EGBUNIWE FNP (NPI 1679848006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679848006 NPI number — MARY NNEKA UKPABI-EGBUNIWE FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UKPABI-EGBUNIWE
Provider First Name:
MARY
Provider Middle Name:
NNEKA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679848006
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4260 CROSSINGS BLVD
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
PRINCE GEORGE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23875-1400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-452-5800
Provider Business Practice Location Address Fax Number:
804-452-5801
Provider Enumeration Date:
03/19/2012

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: 363LF0000X , with the licence number:  0024171023 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 0024171023 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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