Provider Demographics
NPI:1194326991
Name:IBEH, EUCHARIA U
Entity type:Individual
Prefix:
First Name:EUCHARIA
Middle Name:U
Last Name:IBEH
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 1:468 SMITHFIELD RD STE B
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-4266
Mailing Address - Country:US
Mailing Address - Phone:401-525-8202
Mailing Address - Fax:308-888-6638
Practice Address - Street 1:468 SMITHFIELD RD STE B
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-4266
Practice Address - Country:US
Practice Address - Phone:140-525-8202
Practice Address - Fax:308-888-6638
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN02357363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1194326991Medicaid