Provider Demographics
NPI:1992413108
Name:ONYEANI, UGORJI WILSON (RN,MD)
Entity type:Individual
Prefix:PROF
First Name:UGORJI
Middle Name:WILSON
Last Name:ONYEANI
Suffix:
Gender:M
Credentials:RN,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 E BROADWAY RD STE 14
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-2254
Mailing Address - Country:US
Mailing Address - Phone:847-766-9779
Mailing Address - Fax:
Practice Address - Street 1:1241 E BROADWAY RD STE 14
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-2254
Practice Address - Country:US
Practice Address - Phone:847-766-9779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ283584163W00000X, 163WP0808X
FLRN9603230163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse