Provider Demographics
NPI:1679072623
Name:UCHEGBU, CHINYERE (LPN)
Entity Type:Individual
Prefix:
First Name:CHINYERE
Middle Name:
Last Name:UCHEGBU
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3516 S KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:STURTEVANT
Mailing Address - State:WI
Mailing Address - Zip Code:53177-2819
Mailing Address - Country:US
Mailing Address - Phone:262-705-3602
Mailing Address - Fax:
Practice Address - Street 1:3516 S KENNEDY DR
Practice Address - Street 2:
Practice Address - City:STURTEVANT
Practice Address - State:WI
Practice Address - Zip Code:53177-2819
Practice Address - Country:US
Practice Address - Phone:262-705-3602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI303422-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse