Provider Demographics
NPI:1578106795
Name:UZONWUNE, VIVIAN T
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:T
Last Name:UZONWUNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:T
Other - Last Name:UDAIGWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:170 NORRISTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-4075
Mailing Address - Country:US
Mailing Address - Phone:267-265-5677
Mailing Address - Fax:
Practice Address - Street 1:11600 CAROLINE RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-2110
Practice Address - Country:US
Practice Address - Phone:215-632-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020953363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health