Healthcare Provider Details

I. General information

NPI: 1972943942
Provider Name (Legal Business Name): CHIOMA A OGBO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 07/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 WINGATE RD
HYDE PARK MA
02136-2419
US

IV. Provider business mailing address

15 WINGATE RD
HYDE PARK MA
02136-2419
US

V. Phone/Fax

Practice location:
  • Phone: 413-512-0399
  • Fax:
Mailing address:
  • Phone: 413-512-0399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2282164
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: