Provider Demographics
NPI:1427535244
Name:UKAEGBU, MAE
Entity Type:Individual
Prefix:
First Name:MAE
Middle Name:
Last Name:UKAEGBU
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 1:1035 EVANDALE LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5305
Mailing Address - Country:US
Mailing Address - Phone:832-713-4848
Mailing Address - Fax:
Practice Address - Street 1:11929 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4755
Practice Address - Country:US
Practice Address - Phone:281-238-8775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX198226164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse