Healthcare Provider Details

I. General information

NPI: 1649006628
Provider Name (Legal Business Name): OGHOGHO NWOKEDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 COURT ST
KEENE NH
03431-1718
US

IV. Provider business mailing address

122 LAFAYETTE RD
NORTH HAMPTON NH
03862-2450
US

V. Phone/Fax

Practice location:
  • Phone: 207-605-6098
  • Fax:
Mailing address:
  • Phone: 207-605-6098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number75720
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number75720
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: