MEDICARE: DR. IKENNA CHIMAEZE OGOBUIRO DNP, MBA, CRNA, APRN

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	163WC0200X	Critical Care Medicine Registered Nurse	845025	TX
2	367500000X	Certified Registered Nurse Anesthetist	1166576	TX

General Provider Information

NPI Number	:	1497367882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IKENNA CHIMAEZE OGOBUIRO DNP, MBA, CRNA, APRN

Provider Business Mailing Address
First Line	:	1761 PLACITAS TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76131-1506
Country	:	US
Telephone Number	:	214-874-8516
Fax Number	:

Provider Business Practice Location Address
First Line	:	1761 PLACITAS TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76131-1506
Country	:	US
Telephone Number	:	214-874-8516
Fax Number	:

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

Provider Enumeration Date	:	08/18/2020
Last Update Date	:	07/28/2024

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