Healthcare Provider Details

I. General information

NPI: 1518569979
Provider Name (Legal Business Name): GOGHENE OGHOGHORIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14606 DALLAS PKWY APT 1031
DALLAS TX
75254-8836
US

IV. Provider business mailing address

14606 DALLAS PKWY APT 1031
DALLAS TX
75254-8836
US

V. Phone/Fax

Practice location:
  • Phone: 214-497-2058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number327741
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: