Provider Demographics
NPI:1679991822
Name:EKWONYE, UCHENNA (RN)
Entity Type:Individual
Prefix:MR
First Name:UCHENNA
Middle Name:
Last Name:EKWONYE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:UCHENNA
Other - Middle Name:
Other - Last Name:EKWONYE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:5310 OLD COURT RD STE 105
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-5281
Mailing Address - Country:US
Mailing Address - Phone:443-687-2527
Mailing Address - Fax:
Practice Address - Street 1:5310 OLD COURT RD STE 105
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-5281
Practice Address - Country:US
Practice Address - Phone:443-687-2527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR181213163W00000X
MDLP44931164W00000X
MDA00127050376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No376K00000XNursing Service Related ProvidersNurse's Aide