Healthcare Provider Details

I. General information

NPI: 1235498742
Provider Name (Legal Business Name): CHRISTIANA C WOGU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2012
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 LENOX AVE
NEW YORK NY
10037-1802
US

IV. Provider business mailing address

506 LENOX AVE
NEW YORK NY
10037-1802
US

V. Phone/Fax

Practice location:
  • Phone: 212-939-8521
  • Fax: 212-939-8337
Mailing address:
  • Phone: 212-939-8521
  • Fax: 212-939-8337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number431569-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: