Provider Demographics
NPI:1114615994
Name:UKWUOMA, AGAEZI ULOMA
Entity Type:Individual
Prefix:
First Name:AGAEZI
Middle Name:ULOMA
Last Name:UKWUOMA
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 1:601 MENAUL BLVD NE UNIT 3303
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1549
Mailing Address - Country:US
Mailing Address - Phone:832-662-8294
Mailing Address - Fax:
Practice Address - Street 1:601 MENAUL BLVD NE UNIT 3303
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1549
Practice Address - Country:US
Practice Address - Phone:832-662-8294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist