Provider Demographics
NPI:1184120586
Name:UGWUIBE, GWENDOLINE O (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:GWENDOLINE
Middle Name:O
Last Name:UGWUIBE
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1531 S ALAMEDA ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-3109
Mailing Address - Country:US
Mailing Address - Phone:361-888-4745
Mailing Address - Fax:361-888-4795
Practice Address - Street 1:7229 FOREST AVE HIGHLAND II BUILDING
Practice Address - Street 2:STE 111
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226
Practice Address - Country:US
Practice Address - Phone:804-687-4793
Practice Address - Fax:855-618-6655
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136441363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner