Provider Demographics
NPI:1013660745
Name:UDUEVBO, GERTRUDE
Entity Type:Individual
Prefix:
First Name:GERTRUDE
Middle Name:
Last Name:UDUEVBO
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 1:8502 121ST ST
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3211
Mailing Address - Country:US
Mailing Address - Phone:347-405-5875
Mailing Address - Fax:
Practice Address - Street 1:8502 121ST ST
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-3211
Practice Address - Country:US
Practice Address - Phone:347-405-5875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY808558163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse