Provider Demographics
NPI:1568721470
Name:UKACHUKWU, IFEOMA (NP)
Entity Type:Individual
Prefix:
First Name:IFEOMA
Middle Name:
Last Name:UKACHUKWU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:IFEOMA
Other - Middle Name:
Other - Last Name:EZEBUILO-UKACHUKWU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:9609 CULLEN BLVD.
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77051
Mailing Address - Country:US
Mailing Address - Phone:713-848-8120
Mailing Address - Fax:833-617-2471
Practice Address - Street 1:9609 CULLEN BLVD.
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77051
Practice Address - Country:US
Practice Address - Phone:713-848-8120
Practice Address - Fax:833-617-2471
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337046-1363LF0000X
NYF403190363LP0808X
TXAP124717363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health