Provider Demographics
NPI:1346752433
Name:UKAEGBU, AGATHA N (NP)
Entity Type:Individual
Prefix:MRS
First Name:AGATHA
Middle Name:N
Last Name:UKAEGBU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8915 MAYFLOWER RD
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4371
Mailing Address - Country:US
Mailing Address - Phone:443-857-4507
Mailing Address - Fax:
Practice Address - Street 1:8915 MAYFLOWER RD
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-4371
Practice Address - Country:US
Practice Address - Phone:443-857-4507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-29
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR143807363LP0808X
MD2017019195363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health