Provider Demographics
NPI:1710224647
Name:UKACHUKWU, CAROLINE CHIOMA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:CHIOMA
Last Name:UKACHUKWU
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MRS
Other - First Name:CAROLINE
Other - Middle Name:CHIOMA
Other - Last Name:UKACHUKWU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, MSN,ACNP-BC
Mailing Address - Street 1:6565 FANNIN ST. MGJ. SUIT 11,
Mailing Address - Street 2:THE METHODIST HOSPITAL MARY GIBBS
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-441-1032
Mailing Address - Fax:
Practice Address - Street 1:6565 FANNIN ST. MGJ. SUIT 11
Practice Address - Street 2:THE METHODIST HOSPITAL, MARY GIBBS
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-441-1032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX578560275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit