Provider Demographics
NPI:1356987358
Name:UKOENINN, OFONMBUK
Entity type:Individual
Prefix:
First Name:OFONMBUK
Middle Name:
Last Name:UKOENINN
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 1:401 N HIGH POINT RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1849
Mailing Address - Country:US
Mailing Address - Phone:573-999-0916
Mailing Address - Fax:608-821-0577
Practice Address - Street 1:401 N HIGH POINT RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1849
Practice Address - Country:US
Practice Address - Phone:573-999-0916
Practice Address - Fax:608-821-0577
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI151614163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health