Healthcare Provider Details

I. General information

NPI: 1760034086
Provider Name (Legal Business Name): PATIENCE OGHOMWENYEMWEN AKUGUE APRN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 ELM ST STE 202B
MONROE CT
06468-2284
US

IV. Provider business mailing address

324 ELM ST STE 202B
MONROE CT
06468-2284
US

V. Phone/Fax

Practice location:
  • Phone: 203-880-5335
  • Fax:
Mailing address:
  • Phone: 860-888-6270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8310
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: