Provider Demographics
NPI:1710004759
Name:UKPONG, DAWN DEBORRAH (RNFA)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:DEBORRAH
Last Name:UKPONG
Suffix:
Gender:F
Credentials:RNFA
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 45319
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70895-4319
Mailing Address - Country:US
Mailing Address - Phone:225-505-3225
Mailing Address - Fax:225-926-0935
Practice Address - Street 1:8508 GREENWELL SPRINGS RD
Practice Address - Street 2:APT 209
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70814-2425
Practice Address - Country:US
Practice Address - Phone:225-505-3225
Practice Address - Fax:225-926-0935
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN110507163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant