Provider Demographics
NPI:1134941404
Name:ILECHIE, MARY UZOMA (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:UZOMA
Last Name:ILECHIE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:609-914-6000
Mailing Address - Fax:609-914-6182
Practice Address - Street 1:175 MADISON AVE FL 1
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-2099
Practice Address - Country:US
Practice Address - Phone:609-914-6000
Practice Address - Fax:609-914-6182
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15191600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty