Healthcare Provider Details

I. General information

NPI: 1528549219
Provider Name (Legal Business Name): CHIKA I OGBOLU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHIKA I UMEJEI OGBOLU

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W WASHINGTON ST STE 4
SUFFOLK VA
23434-5320
US

IV. Provider business mailing address

721 REDLEAFE CIR
CHESAPEAKE VA
23320-3226
US

V. Phone/Fax

Practice location:
  • Phone: 575-209-4607
  • Fax: 757-300-5724
Mailing address:
  • Phone: 757-209-4607
  • Fax: 757-300-5724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024176503
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024176503
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: