Provider Demographics
NPI:1043786114
Name:USIGBE, CHRISTOPHER OMON
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:OMON
Last Name:USIGBE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 ECHO BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89086-1333
Mailing Address - Country:US
Mailing Address - Phone:702-984-9330
Mailing Address - Fax:
Practice Address - Street 1:1311 S MARYLAND PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3309
Practice Address - Country:US
Practice Address - Phone:702-984-9330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1405284498163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool