Healthcare Provider Details

I. General information

NPI: 1982247524
Provider Name (Legal Business Name): ONYEBUCHI OGBO PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2019
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 WILLARD ST STE 400
QUINCY MA
02169-7469
US

IV. Provider business mailing address

72 KILBURN ST
NEW BEDFORD MA
02740-7321
US

V. Phone/Fax

Practice location:
  • Phone: 339-502-0871
  • Fax:
Mailing address:
  • Phone: 339-502-0871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2274351
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: