Provider Demographics
NPI:1679620983
Name:IHEGARANYA, UDOCHI
Entity type:Individual
Prefix:
First Name:UDOCHI
Middle Name:
Last Name:IHEGARANYA
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 1:2924 TUCKLAND DR.
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-5262
Mailing Address - Country:US
Mailing Address - Phone:919-821-0107
Mailing Address - Fax:919-823-9392
Practice Address - Street 1:2924 TUCKLAND DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-5262
Practice Address - Country:US
Practice Address - Phone:919-821-0107
Practice Address - Fax:919-823-9392
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3471374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC20-4333863Medicaid