Provider Demographics
NPI:1053087742
Name:NDUKWE-UGA, NDIDI (LPN)
Entity Type:Individual
Prefix:MRS
First Name:NDIDI
Middle Name:
Last Name:NDUKWE-UGA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-1546
Mailing Address - Country:US
Mailing Address - Phone:617-233-4202
Mailing Address - Fax:
Practice Address - Street 1:102 SUMMER ST
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-1546
Practice Address - Country:US
Practice Address - Phone:617-233-4202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-21
Last Update Date:2021-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN60051164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty