Provider Demographics
NPI:1861018624
Name:UDO, NSE T
Entity Type:Individual
Prefix:
First Name:NSE
Middle Name:T
Last Name:UDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3414 DEREK LN
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-8327
Mailing Address - Country:US
Mailing Address - Phone:405-822-8555
Mailing Address - Fax:
Practice Address - Street 1:3414 DEREK LN
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-8327
Practice Address - Country:US
Practice Address - Phone:405-822-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator