Provider Demographics
NPI:1033708383
Name:UKAZIM, GRACE IJEOMA
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:IJEOMA
Last Name:UKAZIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5808 BURNET RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-1100
Mailing Address - Country:US
Mailing Address - Phone:512-454-6691
Mailing Address - Fax:
Practice Address - Street 1:5808 BURNET RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-1100
Practice Address - Country:US
Practice Address - Phone:512-454-6691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician