Healthcare Provider Details

I. General information

NPI: 1558736843
Provider Name (Legal Business Name): IJEOMA OGBONNAYA CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2015
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 DUNLAP ST N
SAINT PAUL MN
55104-4201
US

IV. Provider business mailing address

45 10TH ST W
SAINT PAUL MN
55102-1062
US

V. Phone/Fax

Practice location:
  • Phone: 612-250-1088
  • Fax: 651-290-9200
Mailing address:
  • Phone: 651-602-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP4237
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: