Provider Demographics
NPI:1851165914
Name:UKWUANI, DORATHY IFEOMA
Entity Type:Individual
Prefix:
First Name:DORATHY
Middle Name:IFEOMA
Last Name:UKWUANI
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 1:121 BROOKSIDE AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111
Mailing Address - Country:US
Mailing Address - Phone:862-224-5638
Mailing Address - Fax:
Practice Address - Street 1:121 BROOKSIDE AVE
Practice Address - Street 2:APT 3
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111
Practice Address - Country:US
Practice Address - Phone:862-224-5638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346728164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty