Healthcare Provider Details

I. General information

NPI: 1801335351
Provider Name (Legal Business Name): CHINENYE OGBONNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 ADRIENNE DR
ANN ARBOR MI
48103-4412
US

IV. Provider business mailing address

2675 ADRIENNE DR
ANN ARBOR MI
48103-4412
US

V. Phone/Fax

Practice location:
  • Phone: 734-352-0713
  • Fax:
Mailing address:
  • Phone: 734-352-0713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704317732
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704317732
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: