Healthcare Provider Details

I. General information

NPI: 1437976727
Provider Name (Legal Business Name): SHAJNA CHARLI'Z OGBOLU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 W COLLEGE ST
GRAPEVINE TX
76051-3565
US

IV. Provider business mailing address

3006 GUADALUPE DR
FORNEY TX
75126-6961
US

V. Phone/Fax

Practice location:
  • Phone: 817-481-1588
  • Fax:
Mailing address:
  • Phone: 214-863-9734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number1037438
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number1037438
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: