Provider Demographics
NPI:1225836471
Name:UDO, JOHN NDUBUISI (FNP, APRN)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:NDUBUISI
Last Name:UDO
Suffix:
Gender:
Credentials:FNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6325 FOXLYN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-0832
Mailing Address - Country:US
Mailing Address - Phone:702-487-0013
Mailing Address - Fax:
Practice Address - Street 1:1721 E CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-1902
Practice Address - Country:US
Practice Address - Phone:702-685-0620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV849359363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty