Provider Demographics
NPI:1285191254
Name:ENYIOKO, OGECHI NITA (FNP)
Entity Type:Individual
Prefix:
First Name:OGECHI
Middle Name:NITA
Last Name:ENYIOKO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29714 SOMERSET DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-1871
Mailing Address - Country:US
Mailing Address - Phone:248-325-7093
Mailing Address - Fax:
Practice Address - Street 1:30500 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2195
Practice Address - Country:US
Practice Address - Phone:248-325-7093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704289385363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily