Provider Demographics
NPI:1851968515
Name:UZONWANNE, LYNDA NNEKA
Entity Type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:NNEKA
Last Name:UZONWANNE
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 1:540 NORTH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7149
Mailing Address - Country:US
Mailing Address - Phone:908-588-2445
Mailing Address - Fax:908-558-0170
Practice Address - Street 1:540 NORTH AVE STE 3
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-7149
Practice Address - Country:US
Practice Address - Phone:908-588-2445
Practice Address - Fax:908-558-0170
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01162900363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health