Healthcare Provider Details

I. General information

NPI: 1881463719
Provider Name (Legal Business Name): OGECHI EKE BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OGECHI MARY EKE BSN, RN

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 COLUMBIA RD APT 11
DORCHESTER MA
02121-3124
US

IV. Provider business mailing address

143 COLUMBIA RD
DORCHESTER MA
02121-3154
US

V. Phone/Fax

Practice location:
  • Phone: 857-210-4361
  • Fax:
Mailing address:
  • Phone: 857-210-4361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAG08260023
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN2386686
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: