Healthcare Provider Details

I. General information

NPI: 1427355734
Provider Name (Legal Business Name): IJEOMA JULIE OGUNLADE FNP-BC, CPON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2011
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 CENTRAL ST
STOUGHTON MA
02072-4401
US

IV. Provider business mailing address

206 BRITTON AVE
STOUGHTON MA
02072-2578
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax: 508-533-9475
Mailing address:
  • Phone: 781-436-5696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number266456
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: