Healthcare Provider Details

I. General information

NPI: 1730007824
Provider Name (Legal Business Name): NDUKA KELECHI OZULUMBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 MOULTON ST
BROCKTON MA
02302-3210
US

IV. Provider business mailing address

33 MOULTON ST
BROCKTON MA
02302-3210
US

V. Phone/Fax

Practice location:
  • Phone: 270-227-2185
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN10032369
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: