Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DE61189226 | WA |
Y | 213EG0000X | General Practice | DE61189226 | WA |
NPI | 1003586785 |
---|---|
Provider Name | Dr. Udechukwu Iheduru |
First Address | Pasco, WA 99301-9207 |
Second Address | Pasco, WA 99301-9822 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2021 |
Last Update Date | 15/09/2021 |