Provider Demographics
NPI:1104381904
Name:OGUGUO, NNEOMA M (NP)
Entity Type:Individual
Prefix:
First Name:NNEOMA
Middle Name:M
Last Name:OGUGUO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 SOMERTON CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2979
Mailing Address - Country:US
Mailing Address - Phone:240-552-0267
Mailing Address - Fax:
Practice Address - Street 1:7676 NEW HAMPSHIRE AVE STE 420
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-7516
Practice Address - Country:US
Practice Address - Phone:240-552-0267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR145711363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily