Provider Demographics
NPI:1639676026
Name:UKOMADU, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:UKOMADU
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 1:7480 SAINT AUBURN DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-3713
Mailing Address - Country:US
Mailing Address - Phone:313-510-6386
Mailing Address - Fax:
Practice Address - Street 1:7480 SAINT AUBURN DR
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-3713
Practice Address - Country:US
Practice Address - Phone:313-510-6386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704296401163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse