Healthcare Provider Details

I. General information

NPI: 1497695761
Provider Name (Legal Business Name): JOSEPH AMARACHI OGBANSIEGBE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 04/04/2026
Certification Date: 04/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 NE 139TH ST
VANCOUVER WA
98686-2742
US

IV. Provider business mailing address

143 BROOKBERRY CIR
CHAPEL HILL NC
27517-8694
US

V. Phone/Fax

Practice location:
  • Phone: 360-397-1985
  • Fax: 360-604-1604
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: