Provider Demographics
NPI:1720296635
Name:UKAGA, CHIATUOGU
Entity Type:Individual
Prefix:
First Name:CHIATUOGU
Middle Name:
Last Name:UKAGA
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 1:8814 PHEASANT RUN RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-8887
Mailing Address - Country:US
Mailing Address - Phone:651-702-5631
Mailing Address - Fax:651-731-7616
Practice Address - Street 1:1239 PAYNE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-3538
Practice Address - Country:US
Practice Address - Phone:651-209-8350
Practice Address - Fax:651-209-8353
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 143046-2363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN500003880Medicare UPIN