Provider Demographics
NPI:1144343070
Name:OBI-UCHE, STELLAGREG NKECHINYERE (MA, RT)
Entity type:Individual
Prefix:MRS
First Name:STELLAGREG
Middle Name:NKECHINYERE
Last Name:OBI-UCHE
Suffix:
Gender:F
Credentials:MA, RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 ACORN CT
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-3156
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1454 ACORN CT
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-3156
Practice Address - Country:US
Practice Address - Phone:281-835-9720
Practice Address - Fax:281-835-8492
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009512171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009512Medicaid