Healthcare Provider Details

I. General information

NPI: 1215578091
Provider Name (Legal Business Name): LUCY OGECHI EFOBI DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 CLINTON AVE LOWR LEVEL
NEWARK NJ
07108-2809
US

IV. Provider business mailing address

194 CLINTON AVE LOWR LEVEL
NEWARK NJ
07108-2809
US

V. Phone/Fax

Practice location:
  • Phone: 862-240-1461
  • Fax: 862-240-1465
Mailing address:
  • Phone: 862-240-1461
  • Fax: 862-240-1465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00968300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: