Provider Demographics
NPI:1992394894
Name:UGWUEGBULAM, IFEOMA
Entity Type:Individual
Prefix:
First Name:IFEOMA
Middle Name:
Last Name:UGWUEGBULAM
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 1:500 WEBSTER RD LOT 511
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-4222
Mailing Address - Country:US
Mailing Address - Phone:256-658-1519
Mailing Address - Fax:
Practice Address - Street 1:500 WEBSTER RD LOT 511
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36832-4222
Practice Address - Country:US
Practice Address - Phone:256-658-1519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program