Provider Demographics
NPI:1093564791
Name:UMOERA, PATRICIA EFE ANNE
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:EFE ANNE
Last Name:UMOERA
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 1:8633 EDINBROOK XING APT 350
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-4011
Mailing Address - Country:US
Mailing Address - Phone:267-361-9495
Mailing Address - Fax:
Practice Address - Street 1:8633 EDINBROOK XING APT 350
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-4011
Practice Address - Country:US
Practice Address - Phone:267-361-9495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN416159171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor