Healthcare Provider Details

I. General information

NPI: 1730722075
Provider Name (Legal Business Name): NICHELE OGLESBY MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N 3RD ST
HARRISBURG PA
17110-1904
US

IV. Provider business mailing address

1268 2ND ST FRNT
HARRISBURG PA
17113-1104
US

V. Phone/Fax

Practice location:
  • Phone: 717-782-2750
  • Fax:
Mailing address:
  • Phone: 609-742-4795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number958
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: