Provider Demographics
NPI:1861036758
Name:UKERETI, HAPPY ITIOMEMENA (CPRSS)
Entity type:Individual
Prefix:
First Name:HAPPY
Middle Name:ITIOMEMENA
Last Name:UKERETI
Suffix:
Gender:M
Credentials:CPRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7117 E RENO AVE
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4444
Mailing Address - Country:US
Mailing Address - Phone:405-610-5242
Mailing Address - Fax:
Practice Address - Street 1:7117 E RENO AVE
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4444
Practice Address - Country:US
Practice Address - Phone:405-610-5242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist