MEDICARE: OKO NWOGBURU

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	172A00000X	Driver

General Provider Information

NPI Number	:	1548786361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OKO NWOGBURU

Provider Business Mailing Address
First Line	:	5540 MAPLE CLUSTER CT
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-7195
Country	:	US
Telephone Number	:	757-472-3200
Fax Number	:

Provider Business Practice Location Address
First Line	:	5540 MAPLE CLUSTER CT
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-7195
Country	:	US
Telephone Number	:	757-472-3200
Fax Number	:

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

Provider Enumeration Date	:	08/15/2017
Last Update Date	:	07/21/2022

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Directions to “ OKO NWOGBURU ” Practice Location

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