Healthcare Provider Details

I. General information

NPI: 1871315564
Provider Name (Legal Business Name): NKEIRUKA ANN OGBONNA DNP, CNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NKEIRUKA ANN UGWU

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 33RD ST S
SAINT CLOUD MN
56301-9604
US

IV. Provider business mailing address

2515 16TH AVE SE
SAINT CLOUD MN
56304-8555
US

V. Phone/Fax

Practice location:
  • Phone: 320-251-8181
  • Fax:
Mailing address:
  • Phone: 320-224-8617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12228
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: