Provider Demographics
NPI:1710525019
Name:UGWU, MERCY IFEOMA
Entity Type:Individual
Prefix:
First Name:MERCY
Middle Name:IFEOMA
Last Name:UGWU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 S 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-4915
Mailing Address - Country:US
Mailing Address - Phone:918-683-0753
Mailing Address - Fax:918-913-3043
Practice Address - Street 1:350 S 40TH ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-4915
Practice Address - Country:US
Practice Address - Phone:918-683-0753
Practice Address - Fax:918-683-5677
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31349363LA2100X
OK135280363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care