Provider Demographics
NPI:1366642266
Name:MGBEKONYE, JUDE UCHENNA (CNA)
Entity Type:Individual
Prefix:
First Name:JUDE
Middle Name:UCHENNA
Last Name:MGBEKONYE
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6735 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-3408
Mailing Address - Country:US
Mailing Address - Phone:219-689-3710
Mailing Address - Fax:
Practice Address - Street 1:6735 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-3408
Practice Address - Country:US
Practice Address - Phone:219-689-3710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN44030600684374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide