Healthcare Provider Details

I. General information

NPI: 1225510613
Provider Name (Legal Business Name): ASIM OGBONNA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16714 VILLAGE VIEW TRL
SUGAR LAND TX
77498-7200
US

IV. Provider business mailing address

14950 HEATHROW FOREST PKWY STE 250
HOUSTON TX
77032-3845
US

V. Phone/Fax

Practice location:
  • Phone: 183-235-9693
  • Fax:
Mailing address:
  • Phone: 281-921-2301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number806600
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: