Provider Demographics
NPI:1720698442
Name:UGBO, IFEOMA LAURIETTA (FNP)
Entity Type:Individual
Prefix:MS
First Name:IFEOMA
Middle Name:LAURIETTA
Last Name:UGBO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:IFEOMA
Other - Middle Name:LAURIETTA
Other - Last Name:UGBO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:178 QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-2803
Mailing Address - Country:US
Mailing Address - Phone:508-526-7400
Mailing Address - Fax:508-894-0412
Practice Address - Street 1:178 QUINCY AVE
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-2803
Practice Address - Country:US
Practice Address - Phone:508-586-7400
Practice Address - Fax:508-894-0412
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2281081163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse