Provider Demographics
NPI:1811497704
Name:UDO, CLEMENT OKON
Entity type:Individual
Prefix:
First Name:CLEMENT
Middle Name:OKON
Last Name:UDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3528 HUTCH DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-8949
Mailing Address - Country:US
Mailing Address - Phone:972-878-7238
Mailing Address - Fax:
Practice Address - Street 1:3528 HUTCH DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-8949
Practice Address - Country:US
Practice Address - Phone:972-878-7238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX329957164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse