MEDICARE: CHIOMA B OGBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	344960	TX

General Provider Information

NPI Number	:	1881291466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHIOMA B OGBA

Provider Business Mailing Address
First Line	:	505 CONSTELLATION CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76108-3894
Country	:	US
Telephone Number	:	817-987-3019
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 CONSTELLATION CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76108-3894
Country	:	US
Telephone Number	:	817-987-3019
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2020
Last Update Date	:	10/06/2020

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