Provider Demographics
NPI:1568701092
Name:UKANWOKE, EDITH UJU
Entity Type:Individual
Prefix:MS
First Name:EDITH
Middle Name:UJU
Last Name:UKANWOKE
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 1:1304 DOVER GLEN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-1498
Mailing Address - Country:US
Mailing Address - Phone:713-585-6531
Mailing Address - Fax:
Practice Address - Street 1:1304 DOVER GLEN DR
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-1498
Practice Address - Country:US
Practice Address - Phone:713-585-6531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner