Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 4704264105 | MI |
NPI | 1033413596 |
---|---|
Provider Name | Chinwe Carol Ugonna |
First Address | Canton, MI 48187-3452 |
Second Address | Detroit, MI 48201-2018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2010 |
Last Update Date | 21/03/2012 |