Provider Demographics
NPI:1093932725
Name:UNAEGBU, THEOPHILUS AZUBUIKE (RN)
Entity type:Individual
Prefix:
First Name:THEOPHILUS
Middle Name:AZUBUIKE
Last Name:UNAEGBU
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-4126
Mailing Address - Country:US
Mailing Address - Phone:781-963-1067
Mailing Address - Fax:
Practice Address - Street 1:465 NORTH ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-4126
Practice Address - Country:US
Practice Address - Phone:781-963-1067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA206000163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0700851Medicaid