Provider Demographics
NPI:1780095000
Name:MOCHAA-UCHEFUNA, CHUKWUDOZIE (CRNP-FAMILY)
Entity type:Individual
Prefix:
First Name:CHUKWUDOZIE
Middle Name:
Last Name:MOCHAA-UCHEFUNA
Suffix:
Gender:M
Credentials:CRNP-FAMILY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 S ATHOL AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-3405
Mailing Address - Country:US
Mailing Address - Phone:410-947-3052
Mailing Address - Fax:
Practice Address - Street 1:22 S ATHOL AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-3405
Practice Address - Country:US
Practice Address - Phone:410-947-3052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR183739363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily