Provider Demographics
NPI:1720822372
Name:UDE, OBIAMAKA
Entity type:Individual
Prefix:
First Name:OBIAMAKA
Middle Name:
Last Name:UDE
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 1:8402 SAVANNA OAKS LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-9460
Mailing Address - Country:US
Mailing Address - Phone:952-239-2175
Mailing Address - Fax:
Practice Address - Street 1:8402 SAVANNA OAKS LN
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-9460
Practice Address - Country:US
Practice Address - Phone:952-239-2175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR2106494163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty