Provider Demographics
NPI:1235729773
Name:UREVBU, OGHENETEGIRI (APRN GAA- NP)
Entity Type:Individual
Prefix:
First Name:OGHENETEGIRI
Middle Name:
Last Name:UREVBU
Suffix:
Gender:F
Credentials:APRN GAA- NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PHILLIP'S PEDIATRICS, PC
Mailing Address - Street 2:455 S MAIN STREET, STE 103
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313
Mailing Address - Country:US
Mailing Address - Phone:912-876-6868
Mailing Address - Fax:912-876-6566
Practice Address - Street 1:PHILLIP'S PEDIATRICS, PC
Practice Address - Street 2:455 S MAIN STREET, STE 103
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313
Practice Address - Country:US
Practice Address - Phone:912-876-6868
Practice Address - Fax:912-876-6566
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAA-NP000025363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPENDINGMedicaid