Provider Demographics
NPI:1811303829
Name:UKPOLO, CLAUDIA
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:
Last Name:UKPOLO
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 1:2703 GEN DEGAULLE DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-6222
Mailing Address - Country:US
Mailing Address - Phone:504-354-2103
Mailing Address - Fax:
Practice Address - Street 1:2703 GEN DEGAULLE DR STE C
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-6222
Practice Address - Country:US
Practice Address - Phone:504-354-2103
Practice Address - Fax:504-354-2283
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09945363LF0000X, 363LP0808X
DELG-0000732363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2515691Medicaid