Provider Demographics
NPI:1164613089
Name:OLEMGBE, STANLEY UCHENNA
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:UCHENNA
Last Name:OLEMGBE
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 1:12375 SW HALL BLVD
Mailing Address - Street 2:APT 11
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6235
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12375 SW HALL BLVD
Practice Address - Street 2:APT 11
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6235
Practice Address - Country:US
Practice Address - Phone:503-238-0769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion