Provider Demographics
NPI:1982178364
Name:UKPERE, SUSAN E
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:E
Last Name:UKPERE
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 1:950 EVERGREEN AVE APT 12H
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-4541
Mailing Address - Country:US
Mailing Address - Phone:718-915-2608
Mailing Address - Fax:
Practice Address - Street 1:950 EVERGREEN AVE APT 12H
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-4541
Practice Address - Country:US
Practice Address - Phone:718-915-2608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316768164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse