Healthcare Provider Details

I. General information

NPI: 1245675974
Provider Name (Legal Business Name): ROSE NWAFOR OGBONNA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 EAST 210TH ST
BRONX NY
10467
US

IV. Provider business mailing address

2749 YATES AVE
BRONX NY
10469-5330
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-9000
  • Fax:
Mailing address:
  • Phone: 347-484-1631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF337671-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: