Healthcare Provider Details

I. General information

NPI: 1306355862
Provider Name (Legal Business Name): FRANCES UJU OGUDEBE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2017
Last Update Date: 09/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

968 FAIRFIELD AVE
BRIDGEPORT CT
06605-1116
US

IV. Provider business mailing address

45 FOUNTAIN TERRACE
NEW HAVEN CT
06515
US

V. Phone/Fax

Practice location:
  • Phone: 203-330-6000
  • Fax:
Mailing address:
  • Phone: 203-668-1109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number129669
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: