Provider Demographics
NPI:1134559461
Name:NCHICHUPA, URSULA
Entity type:Individual
Prefix:
First Name:URSULA
Middle Name:
Last Name:NCHICHUPA
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 1:4195 SUNDANCE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-1858
Mailing Address - Country:US
Mailing Address - Phone:248-914-8920
Mailing Address - Fax:
Practice Address - Street 1:4195 SUNDANCE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-1858
Practice Address - Country:US
Practice Address - Phone:248-914-8920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN3966477163W00000X
OHPN154649164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse