Healthcare Provider Details

I. General information

NPI: 1548950397
Provider Name (Legal Business Name): EVBUOSA HANNY OGBEBOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/15/2023
Certification Date: 05/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 10TH ST
NIAGARA FALLS NY
14301-1813
US

IV. Provider business mailing address

5 OFFSHORE DR APT 302
EAST AMHERST NY
14051-2293
US

V. Phone/Fax

Practice location:
  • Phone: 716-278-4000
  • Fax:
Mailing address:
  • Phone: 201-852-9377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number740419
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: