Healthcare Provider Details

I. General information

NPI: 1447738760
Provider Name (Legal Business Name): BRIAN OGECHI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 07/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14232 DALLAS PKWY APT 901
DALLAS TX
75254-2931
US

IV. Provider business mailing address

14232 DALLAS PKWY APT 901
DALLAS TX
75254-2931
US

V. Phone/Fax

Practice location:
  • Phone: 469-305-9566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number847984
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: