Provider Demographics
NPI:1164140083
Name:OGBONNAYA, PRISCA UGOCHI (APN)
Entity Type:Individual
Prefix:
First Name:PRISCA
Middle Name:UGOCHI
Last Name:OGBONNAYA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:983 TOWNLEY AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7562
Mailing Address - Country:US
Mailing Address - Phone:973-634-3651
Mailing Address - Fax:
Practice Address - Street 1:983 TOWNLEY AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-7562
Practice Address - Country:US
Practice Address - Phone:973-634-3651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01323200363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty