Healthcare Provider Details

I. General information

NPI: 1427789387
Provider Name (Legal Business Name): OLIVE CHIEKWUGO OCHUBA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NE MOTHER JOSEPH PL
VANCOUVER WA
98664-3200
US

IV. Provider business mailing address

400 NE MOTHER JOSEPH PL
VANCOUVER WA
98664-3200
US

V. Phone/Fax

Practice location:
  • Phone: 360-256-2000
  • Fax:
Mailing address:
  • Phone: 360-256-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP05742
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD61686266
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: