Provider Demographics
NPI:1134776149
Name:NWANKPA, UKACHI O (FNP)
Entity type:Individual
Prefix:MRS
First Name:UKACHI
Middle Name:O
Last Name:NWANKPA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 WARWICK DR
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-1996
Mailing Address - Country:US
Mailing Address - Phone:773-407-7814
Mailing Address - Fax:
Practice Address - Street 1:1013 WARWICK DR
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-1996
Practice Address - Country:US
Practice Address - Phone:773-407-7814
Practice Address - Fax:708-980-2953
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.019716363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily