Healthcare Provider Details

I. General information

NPI: 1538933056
Provider Name (Legal Business Name): JOB OGEGA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 MAIN ST # 1234
WORCESTER MA
01608-1723
US

IV. Provider business mailing address

370 MAIN ST # 1234
WORCESTER MA
01608-1723
US

V. Phone/Fax

Practice location:
  • Phone: 603-820-3501
  • Fax:
Mailing address:
  • Phone: 603-820-3501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2346408
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN2346408
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: