Healthcare Provider Details

I. General information

NPI: 1346510690
Provider Name (Legal Business Name): OCHUKO OGHENERHUOHWO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2054 TILLOTSON AVE
BRONX NY
10475-1560
US

IV. Provider business mailing address

1566 VYSE AVE APT2C
BRONX NY
10460-5656
US

V. Phone/Fax

Practice location:
  • Phone: 718-671-2100
  • Fax:
Mailing address:
  • Phone: 718-671-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number649157
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: