Provider Demographics
NPI:1063831824
Name:UBOCHI, BETHEL (NP)
Entity Type:Individual
Prefix:MR
First Name:BETHEL
Middle Name:
Last Name:UBOCHI
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 WOODROSE CT
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-1646
Mailing Address - Country:US
Mailing Address - Phone:920-931-5061
Mailing Address - Fax:541-440-1394
Practice Address - Street 1:2420 SYCAMORE DR APT 58
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-5166
Practice Address - Country:US
Practice Address - Phone:920-931-5061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI173722-30163W00000X
OR202001123363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse