Provider Demographics
NPI:1881332765
Name:ONWUKA, CALEB (LPN)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:
Last Name:ONWUKA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4104 KENSINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-4819
Mailing Address - Country:US
Mailing Address - Phone:405-881-1454
Mailing Address - Fax:
Practice Address - Street 1:4405 NW 4TH ST STE 138
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-6541
Practice Address - Country:US
Practice Address - Phone:405-881-1454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-21
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL0067603164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse