Provider Demographics
NPI:1164990719
Name:AZODE, UGOCHUKWU (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:UGOCHUKWU
Middle Name:
Last Name:AZODE
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 QUANTICO WAY
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-8796
Mailing Address - Country:US
Mailing Address - Phone:443-703-8329
Mailing Address - Fax:
Practice Address - Street 1:7401 QUANTICO WAY
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-8796
Practice Address - Country:US
Practice Address - Phone:443-703-8329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-12
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1048979163W00000X
MD236376363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse