Provider Demographics
NPI:1649714254
Name:UDEBHULU, VERA OMOYE (FNP)
Entity type:Individual
Prefix:
First Name:VERA
Middle Name:OMOYE
Last Name:UDEBHULU
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 1:773 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-4401
Mailing Address - Country:US
Mailing Address - Phone:917-582-4531
Mailing Address - Fax:
Practice Address - Street 1:773 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-4401
Practice Address - Country:US
Practice Address - Phone:917-582-4531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340128-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily