Healthcare Provider Details

I. General information

NPI: 1073826707
Provider Name (Legal Business Name): ANN N OGBONNA REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3546 FIELDCREST LN
YPSILANTI MI
48197-6820
US

IV. Provider business mailing address

3546 FIELDCREST LN
YPSILANTI MI
48197-6820
US

V. Phone/Fax

Practice location:
  • Phone: 734-507-1286
  • Fax: 734-434-8730
Mailing address:
  • Phone: 734-507-1286
  • Fax: 734-434-8730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704178940
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: