Provider Demographics
NPI:1669233292
Name:UBAJIOGU, COLLETTE
Entity type:Individual
Prefix:
First Name:COLLETTE
Middle Name:
Last Name:UBAJIOGU
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 1:7879 MOONWOOD PL
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-9474
Mailing Address - Country:US
Mailing Address - Phone:734-299-1282
Mailing Address - Fax:
Practice Address - Street 1:7879 MOONWOOD PL
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-9474
Practice Address - Country:US
Practice Address - Phone:734-299-1282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704334358363LF0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse