Healthcare Provider Details

I. General information

NPI: 1073807632
Provider Name (Legal Business Name): NELLY O WOLUGBOMS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. NELLY OGHOSOMI ITSUOKO

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W DUE WEST AVE
MADISON TN
37115-4423
US

IV. Provider business mailing address

2711 FOSTER AVE
NASHVILLE TN
37210-5307
US

V. Phone/Fax

Practice location:
  • Phone: 615-227-3000
  • Fax:
Mailing address:
  • Phone: 615-620-8647
  • Fax: 615-515-5773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN0000015556
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: