Provider Demographics
NPI:1336315944
Name:NWOGU, CHARITY
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:
Last Name:NWOGU
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 1:2605 MARION AVE
Mailing Address - Street 2:1 C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-4715
Mailing Address - Country:US
Mailing Address - Phone:917-549-5602
Mailing Address - Fax:
Practice Address - Street 1:2605 MARION AVE
Practice Address - Street 2:1 C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-4715
Practice Address - Country:US
Practice Address - Phone:917-549-5602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-03
Last Update Date:2008-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY287610-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse