Provider Demographics
NPI:1194269993
Name:UDEH, NDIDIAMAKA MONIQUE (NP)
Entity type:Individual
Prefix:
First Name:NDIDIAMAKA
Middle Name:MONIQUE
Last Name:UDEH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15815 IRON CANYON LANE
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394
Mailing Address - Country:US
Mailing Address - Phone:310-259-3398
Mailing Address - Fax:
Practice Address - Street 1:43839 N 15TH ST WEST
Practice Address - Street 2:HIGH DESERT MEDICAL CORP.
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4659
Practice Address - Country:US
Practice Address - Phone:661-945-5984
Practice Address - Fax:661-951-3192
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-13
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005826363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily