Provider Demographics
NPI:1245586353
Name:OGAMBA, THEODORA CHIKA
Entity Type:Individual
Prefix:
First Name:THEODORA
Middle Name:CHIKA
Last Name:OGAMBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 BLUE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-1040
Mailing Address - Country:US
Mailing Address - Phone:617-910-7571
Mailing Address - Fax:
Practice Address - Street 1:360 BLUE HILL AVE
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-1040
Practice Address - Country:US
Practice Address - Phone:617-910-7571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN235866163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse