Provider Demographics
NPI:1023637311
Name:UDOBONG, ESTHER
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:
Last Name:UDOBONG
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 1:15180 OLD HICKORY BLVD APT 915
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-6567
Mailing Address - Country:US
Mailing Address - Phone:678-622-8620
Mailing Address - Fax:
Practice Address - Street 1:15180 OLD HICKORY BLVD APT 915
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-6567
Practice Address - Country:US
Practice Address - Phone:678-622-8620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program