Provider Demographics
NPI:1104322601
Name:AKPAN, UDO NATHANIEL
Entity type:Individual
Prefix:
First Name:UDO
Middle Name:NATHANIEL
Last Name:AKPAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:598 N MONTELLO ST # 5
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2439
Mailing Address - Country:US
Mailing Address - Phone:781-510-9893
Mailing Address - Fax:
Practice Address - Street 1:598 N MONTELLO ST # 5
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2439
Practice Address - Country:US
Practice Address - Phone:781-510-9893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician