Provider Demographics
NPI:1548563232
Name:UZOMBA, BRENDA CHINONSO I (NURSE AIDE)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:CHINONSO
Last Name:UZOMBA
Suffix:I
Gender:F
Credentials:NURSE AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2946 BARCLAY SQ N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-3818
Mailing Address - Country:US
Mailing Address - Phone:614-569-1236
Mailing Address - Fax:
Practice Address - Street 1:2946 BARCLAY SQ N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-3818
Practice Address - Country:US
Practice Address - Phone:614-569-1236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401087780510376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3079207Medicaid