Provider Demographics
NPI:1053716274
Name:UCHENDU, JUSTINA I
Entity type:Individual
Prefix:
First Name:JUSTINA
Middle Name:
Last Name:UCHENDU
Suffix:I
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 1:1404 ROSSER AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3124
Mailing Address - Country:US
Mailing Address - Phone:347-339-6499
Mailing Address - Fax:
Practice Address - Street 1:1404 ROSSER AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-3124
Practice Address - Country:US
Practice Address - Phone:347-339-6499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY646075163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse