Provider Demographics
NPI:1003492885
Name:MBAKWE, CHRISTINE UGONMA
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:UGONMA
Last Name:MBAKWE
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 1:117 TALON GRASP TRL APT 14101
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-1054
Mailing Address - Country:US
Mailing Address - Phone:309-592-9820
Mailing Address - Fax:
Practice Address - Street 1:600 N BELL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2216
Practice Address - Country:US
Practice Address - Phone:737-321-0200
Practice Address - Fax:737-321-0201
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXV4148207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program