Provider Demographics
NPI:1063987063
Name:NDUKA, EBERE (FNP)
Entity type:Individual
Prefix:MRS
First Name:EBERE
Middle Name:
Last Name:NDUKA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 WINTERS LN
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4437
Mailing Address - Country:US
Mailing Address - Phone:410-660-9262
Mailing Address - Fax:
Practice Address - Street 1:405 N PACA ST FL 1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1815
Practice Address - Country:US
Practice Address - Phone:410-779-9609
Practice Address - Fax:443-552-4758
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR194646207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty