Provider Demographics
NPI:1578990693
Name:UDEH, NTAOBASI PATRICK (AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:NTAOBASI
Middle Name:PATRICK
Last Name:UDEH
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10679 HILLINGDON RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163-1431
Mailing Address - Country:US
Mailing Address - Phone:240-856-0529
Mailing Address - Fax:
Practice Address - Street 1:10679 HILLINGDON RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:MD
Practice Address - Zip Code:21163-1431
Practice Address - Country:US
Practice Address - Phone:240-856-0529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR229826363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner