Provider Demographics
NPI:1275895856
Name:MGBEMEJE, STELLA NGOZI (LPN)
Entity Type:Individual
Prefix:MISS
First Name:STELLA
Middle Name:NGOZI
Last Name:MGBEMEJE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1348 WEBSTER AVE
Mailing Address - Street 2:APT. 12G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-1813
Mailing Address - Country:US
Mailing Address - Phone:646-399-1359
Mailing Address - Fax:
Practice Address - Street 1:1348 WEBSTER AVE
Practice Address - Street 2:APT. 12G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-1813
Practice Address - Country:US
Practice Address - Phone:646-399-1359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6987041163W00000X
NY309925-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse