Provider Demographics
NPI:1629585294
Name:UDE, ADAEZE CHIDINMA
Entity Type:Individual
Prefix:
First Name:ADAEZE
Middle Name:CHIDINMA
Last Name:UDE
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 1:606 E MILL ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-0620
Mailing Address - Country:US
Mailing Address - Phone:909-383-3054
Mailing Address - Fax:909-383-3023
Practice Address - Street 1:606 E MILL ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-3436
Practice Address - Country:US
Practice Address - Phone:909-383-3054
Practice Address - Fax:909-383-3023
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA712018163W00000X
CA544334163WC0400X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management