Provider Demographics
NPI:1174847511
Name:UWANDU, IJEOMA CHIDUMAGA
Entity Type:Individual
Prefix:
First Name:IJEOMA
Middle Name:CHIDUMAGA
Last Name:UWANDU
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 1:173 BLUE LEDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-4815
Mailing Address - Country:US
Mailing Address - Phone:617-412-7688
Mailing Address - Fax:
Practice Address - Street 1:173 BLUE LEDGE DR
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-4815
Practice Address - Country:US
Practice Address - Phone:617-412-7688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-14
Last Update Date:2010-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN86221164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse