Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD20060291 | NM |
N | 207QA0401X | Family Doctor - Addiction Medicine | MD20060291 | NM |
NPI | 1114969896 |
---|---|
Provider Name | Melanie M Ukanwa |
First Address | Albuquerque, NM 87125-7453 |
Second Address | Albuquerque, NM 87109-6707 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 31/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
17670721 | (05) | NM |
I68910 | (02) | |
NMAAA2194 | MEDICARE PTAN (01) |