Healthcare Provider Details

I. General information

NPI: 1124508650
Provider Name (Legal Business Name): MARIE CHRISTELLE OGANDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1493 CAMBRIDGE ST
CAMBRIDGE MA
02139-1047
US

IV. Provider business mailing address

9 SUTCLIFFE RD
LYNN MA
01904-1712
US

V. Phone/Fax

Practice location:
  • Phone: 617-665-1000
  • Fax:
Mailing address:
  • Phone: 857-615-5918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2310583
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: