Provider Demographics
NPI:1326159559
Name:UGBOMOH, JUDE CHINEDUM (LVN)
Entity Type:Individual
Prefix:
First Name:JUDE
Middle Name:CHINEDUM
Last Name:UGBOMOH
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-3037
Mailing Address - Country:US
Mailing Address - Phone:972-283-0822
Mailing Address - Fax:972-283-0822
Practice Address - Street 1:1307 MISSION ST
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-3037
Practice Address - Country:US
Practice Address - Phone:972-283-0822
Practice Address - Fax:972-283-0822
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX187723164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse