Provider Demographics
NPI:1508697392
Name:EJINDU, UGONNA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:UGONNA
Middle Name:
Last Name:EJINDU
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 N UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36688-3053
Mailing Address - Country:US
Mailing Address - Phone:870-316-1832
Mailing Address - Fax:
Practice Address - Street 1:307 N UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36688-3053
Practice Address - Country:US
Practice Address - Phone:870-316-1832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL8-0010646363LP0808X
TN36057363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty