Provider Demographics
NPI:1861210080
Name:IGWE, SANDRA UDO
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:UDO
Last Name:IGWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 STEPHENS CREEK PL
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-8759
Mailing Address - Country:US
Mailing Address - Phone:770-899-5445
Mailing Address - Fax:
Practice Address - Street 1:3600 STEPHENS CREEK PL
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-8759
Practice Address - Country:US
Practice Address - Phone:770-899-5445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN223106163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse