Provider Demographics
NPI:1679848006
Name:UKPABI-EGBUNIWE, MARY NNEKA (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:NNEKA
Last Name:UKPABI-EGBUNIWE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:NEW CANTON
Mailing Address - State:VA
Mailing Address - Zip Code:23123-0220
Mailing Address - Country:US
Mailing Address - Phone:434-581-3271
Mailing Address - Fax:434-581-1704
Practice Address - Street 1:4260 CROSSINGS BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875-1400
Practice Address - Country:US
Practice Address - Phone:804-452-5800
Practice Address - Fax:804-452-5801
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171023363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily