Healthcare Provider Details

I. General information

NPI: 1497737399
Provider Name (Legal Business Name): IFEOMA O OGBUEHI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 E ALMOND AVE
MADERA CA
93637-5606
US

IV. Provider business mailing address

4246 W CAPITOLA AVE
FRESNO CA
93722-6010
US

V. Phone/Fax

Practice location:
  • Phone: 559-675-5530
  • Fax: 559-675-5532
Mailing address:
  • Phone: 559-277-9778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15717
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: