Provider Demographics
NPI:1235763863
Name:OGBEIDE, ERNEST (APRN, PMHNP)
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:
Last Name:OGBEIDE
Suffix:
Gender:M
Credentials:APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9119 S EXCHANGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-4225
Mailing Address - Country:US
Mailing Address - Phone:773-768-5000
Mailing Address - Fax:773-978-8367
Practice Address - Street 1:9119 S EXCHANGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-4225
Practice Address - Country:US
Practice Address - Phone:773-768-5000
Practice Address - Fax:773-978-8367
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.020904363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty