Provider Demographics
NPI:1831835339
Name:UZOEWULU, STELLA EKENE CHIDIMMA
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:EKENE CHIDIMMA
Last Name:UZOEWULU
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 1:1775 DEMPSTER ST # 48
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1143
Mailing Address - Country:US
Mailing Address - Phone:847-723-8077
Mailing Address - Fax:
Practice Address - Street 1:1775 DEMPSTER ST # 48
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1143
Practice Address - Country:US
Practice Address - Phone:847-723-8077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-07
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
273R00000X, 390200000X
IL125.0845372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No273R00000XHospital UnitsPsychiatric Unit
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program