Provider Demographics
NPI:1831432319
Name:UWAIFO, ABIEMWENSE QUEEN (FNP)
Entity type:Individual
Prefix:
First Name:ABIEMWENSE
Middle Name:QUEEN
Last Name:UWAIFO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ABIEMWENSE
Other - Middle Name:QUEEN
Other - Last Name:UWAIFO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ABIEMWENSE UWAIFO
Mailing Address - Street 1:4805 COLUMBIA PIKE
Mailing Address - Street 2:
Mailing Address - City:THOMPSONS STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37179-5207
Mailing Address - Country:US
Mailing Address - Phone:615-791-0974
Mailing Address - Fax:
Practice Address - Street 1:4805 COLUMBIA PIKE
Practice Address - Street 2:
Practice Address - City:THOMPSONS STATION
Practice Address - State:TN
Practice Address - Zip Code:37179-5207
Practice Address - Country:US
Practice Address - Phone:615-791-0974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-02
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17493363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily