Provider Demographics
NPI:1205684008
Name:UZOEWULU, IFEANYICHI
Entity type:Individual
Prefix:
First Name:IFEANYICHI
Middle Name:
Last Name:UZOEWULU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 GENDERSEN DR #201
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2642
Mailing Address - Country:US
Mailing Address - Phone:630-297-7708
Mailing Address - Fax:
Practice Address - Street 1:675 GENDERSEN DR #201
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2642
Practice Address - Country:US
Practice Address - Phone:630-297-7708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide