Healthcare Provider Details

I. General information

NPI: 1063013605
Provider Name (Legal Business Name): OGECHI ANN OHIA AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12361 W BOLA DR STE 109
SURPRISE AZ
85378-9021
US

IV. Provider business mailing address

2626 DEERWOOD HEIGHTS LN
MANVEL TX
77578-2058
US

V. Phone/Fax

Practice location:
  • Phone: 623-227-1000
  • Fax:
Mailing address:
  • Phone: 414-659-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP143724
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP143724
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: