Provider Demographics
NPI:1588104772
Name:UZOMA, MARY-PAT
Entity type:Individual
Prefix:
First Name:MARY-PAT
Middle Name:
Last Name:UZOMA
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 1:51 HOVENDON AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-1220
Mailing Address - Country:US
Mailing Address - Phone:508-857-0531
Mailing Address - Fax:508-510-3969
Practice Address - Street 1:51 HOVENDON AVE
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-1220
Practice Address - Country:US
Practice Address - Phone:508-857-0531
Practice Address - Fax:508-510-3969
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN199943163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse