Healthcare Provider Details

I. General information

NPI: 1265808539
Provider Name (Legal Business Name): PHILOMINA OGBONNAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 08/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27139 W SKYE DR
FARMINGTON HILLS MI
48334-5340
US

IV. Provider business mailing address

27139 W SKYE DR
FARMINGTON HILLS MI
48334-5340
US

V. Phone/Fax

Practice location:
  • Phone: 313-529-4155
  • Fax:
Mailing address:
  • Phone: 313-529-4155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704228957
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: