MEDICARE: MRS. AUGUSTINA OGONNAYA OGWUEGBU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	PN.114039	OH

General Provider Information

NPI Number	:	1154562254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AUGUSTINA OGONNAYA OGWUEGBU

Provider Business Mailing Address
First Line	:	1337 W 87TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-1823
Country	:	US
Telephone Number	:	216-961-4501
Fax Number	:

Provider Business Practice Location Address
First Line	:	1337 W 87TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-1823
Country	:	US
Telephone Number	:	216-961-4501
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2009
Last Update Date	:	03/19/2009

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