Provider Demographics
NPI:1336732197
Name:IKE, UCHE (PMHNP)
Entity Type:Individual
Prefix:
First Name:UCHE
Middle Name:
Last Name:IKE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 HONEYSUCKLE VINE DR
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77469-5788
Mailing Address - Country:US
Mailing Address - Phone:267-332-1053
Mailing Address - Fax:
Practice Address - Street 1:2550 W UNION HILLS DR # 350-8943
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-5163
Practice Address - Country:US
Practice Address - Phone:602-551-7009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-12
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1026507363LP0808X
CA95019944363LP0808X
OR202113376NP363LP0808X
AZ256479363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ155795Medicaid