Provider Demographics
NPI:1154753630
Name:UDEMBA, ADAOBI (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:ADAOBI
Middle Name:
Last Name:UDEMBA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 63RD ST
Mailing Address - Street 2:TOP FLOOR
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-5857
Mailing Address - Country:US
Mailing Address - Phone:917-378-2887
Mailing Address - Fax:
Practice Address - Street 1:5010 63RD ST
Practice Address - Street 2:TOP FLOOR
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-5857
Practice Address - Country:US
Practice Address - Phone:917-378-2887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF430688-1363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care