Provider Demographics
NPI:1538640024
Name:MBAKA, UCHE JESSICA (CRNA)
Entity type:Individual
Prefix:
First Name:UCHE
Middle Name:JESSICA
Last Name:MBAKA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:UCHE
Other - Middle Name:JESSICA
Other - Last Name:CHIDOLUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23318 ROSEN MILL DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-2526
Mailing Address - Country:US
Mailing Address - Phone:713-253-3727
Mailing Address - Fax:
Practice Address - Street 1:23318 ROSEN MILL DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-2526
Practice Address - Country:US
Practice Address - Phone:713-253-3727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX764032367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8KK199OtherBCBS
TX392542202OtherCSHCN
TX392542201Medicaid