Healthcare Provider Details

I. General information

NPI: 1255635058
Provider Name (Legal Business Name): LILIAN U OGUJIOFOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 MELROSE AVE
LANSDOWNE PA
19050-2528
US

IV. Provider business mailing address

48 MELROSE AVE
LANSDOWNE PA
19050-2528
US

V. Phone/Fax

Practice location:
  • Phone: 215-833-4505
  • Fax:
Mailing address:
  • Phone: 215-833-4505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP013428
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP025505
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: