Provider Demographics
NPI:1336626498
Name:NIMTOR, UKPERE DANIEL (MD; MSN)
Entity type:Individual
Prefix:DR
First Name:UKPERE
Middle Name:DANIEL
Last Name:NIMTOR
Suffix:
Gender:M
Credentials:MD; MSN
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:140 NUTT RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-3906
Mailing Address - Country:US
Mailing Address - Phone:610-983-1000
Mailing Address - Fax:
Practice Address - Street 1:305 SECOND AVE
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-2658
Practice Address - Country:US
Practice Address - Phone:485-902-8130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-22
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4755872084P0800X
RIMD173532084P0800X
NJ25MA109676002084P0800X
NJ26NJ00975600363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health