Healthcare Provider Details

I. General information

NPI: 1194299842
Provider Name (Legal Business Name): PAMELA O OGBONNA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 MURCHISON DR STE 100
EL PASO TX
79902-4821
US

IV. Provider business mailing address

1310 MURCHISON DR STE 100
EL PASO TX
79902-4821
US

V. Phone/Fax

Practice location:
  • Phone: 915-544-4500
  • Fax:
Mailing address:
  • Phone: 915-544-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP139888
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: