Healthcare Provider Details

I. General information

NPI: 1629367115
Provider Name (Legal Business Name): JESSY RITA OGBU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2851 BRONCO DR SAME
DALLAS TX
75237-3225
US

IV. Provider business mailing address

2851 BRONCO DR
DALLAS TX
75237-3225
US

V. Phone/Fax

Practice location:
  • Phone: 469-735-6843
  • Fax: 972-572-0009
Mailing address:
  • Phone: 469-735-6843
  • Fax: 972-572-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: