Provider Demographics
NPI:1114659117
Name:OGBONNA, AUGUSTINA OLUCHI (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:AUGUSTINA
Middle Name:OLUCHI
Last Name:OGBONNA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 N CEDAR RIDGE DR STE 325
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-3170
Mailing Address - Country:US
Mailing Address - Phone:214-315-3999
Mailing Address - Fax:
Practice Address - Street 1:407 N CEDAR RIDGE DR STE 325
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-3170
Practice Address - Country:US
Practice Address - Phone:214-315-3999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1078108363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health