Healthcare Provider Details

I. General information

NPI: 1326705492
Provider Name (Legal Business Name): OGECHI NWAKEGO OPARA APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SULLIVAN WAY
EWING NJ
08628-3425
US

IV. Provider business mailing address

30 TEAL CT
EAST WINDSOR NJ
08520-2632
US

V. Phone/Fax

Practice location:
  • Phone: 609-633-1500
  • Fax:
Mailing address:
  • Phone: 609-954-2927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01234600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: