Provider Demographics
NPI:1114229051
Name:UDO, INEMESIT (FNP-C)
Entity Type:Individual
Prefix:
First Name:INEMESIT
Middle Name:
Last Name:UDO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9999 KENWORTHY ST STE 1000
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-4412
Mailing Address - Country:US
Mailing Address - Phone:915-298-3434
Mailing Address - Fax:915-751-7257
Practice Address - Street 1:9999 KENWORTHY ST STE 1000
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-4412
Practice Address - Country:US
Practice Address - Phone:915-298-3434
Practice Address - Fax:915-751-7257
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-01700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM476930ZS5HOtherWELLMED PTAN
NM49189Medicaid
NM300521013Medicare UPIN
NM49189Medicaid