Provider Demographics
NPI:1477011229
Name:KOMOLAFE, UCHECHUKWU GENEVIEVE (DNP)
Entity Type:Individual
Prefix:
First Name:UCHECHUKWU
Middle Name:GENEVIEVE
Last Name:KOMOLAFE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3556 MOSSWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310
Mailing Address - Country:US
Mailing Address - Phone:850-867-8785
Mailing Address - Fax:
Practice Address - Street 1:1501 10TH ST
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5044
Practice Address - Country:US
Practice Address - Phone:575-434-2960
Practice Address - Fax:575-434-8724
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-55013363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily