Provider Demographics
NPI:1164903399
Name:UDOH, ANIEKAN (APRN, PMHNP- BC)
Entity type:Individual
Prefix:
First Name:ANIEKAN
Middle Name:
Last Name:UDOH
Suffix:
Gender:F
Credentials:APRN, PMHNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 1ST AVE
Mailing Address - Street 2:SUITE 102 #2096
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2287
Mailing Address - Country:US
Mailing Address - Phone:281-846-5587
Mailing Address - Fax:
Practice Address - Street 1:600 1ST AVE
Practice Address - Street 2:SUITE 102 #2096
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2287
Practice Address - Country:US
Practice Address - Phone:832-433-0465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-25
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1172829363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health