Healthcare Provider Details

I. General information

NPI: 1164140083
Provider Name (Legal Business Name): PRISCA UGOCHI OGBONNAYA APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

983 TOWNLEY AVE
UNION NJ
07083-7562
US

IV. Provider business mailing address

983 TOWNLEY AVE
UNION NJ
07083-7562
US

V. Phone/Fax

Practice location:
  • Phone: 973-634-3651
  • Fax:
Mailing address:
  • Phone: 973-634-3651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01323200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: