MEDICARE: SHAREESE OGHOGHO

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	163W00000X	Registered Nurse	808112	TX
2	363LP2300X	Primary Care Nurse Practitioner	1168726	TX

General Provider Information

NPI Number	:	1801384789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAREESE OGHOGHO

Provider Business Mailing Address
First Line	:	8313 SOUTHWEST FWY STE 105
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1612
Country	:	US
Telephone Number	:	713-773-1102
Fax Number	:

Provider Business Practice Location Address
First Line	:	8313 SOUTHWEST FWY STE 105
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1612
Country	:	US
Telephone Number	:	713-773-1102
Fax Number	:

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

Provider Enumeration Date	:	04/26/2018
Last Update Date	:	11/18/2024

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Directions to “ SHAREESE OGHOGHO ” Practice Location

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