Provider Demographics
NPI:1407350820
Name:OGBONNA, CHOICE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:CHOICE
Middle Name:
Last Name:OGBONNA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3642 FAWN VALLEY DR APT 2058
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-5334
Mailing Address - Country:US
Mailing Address - Phone:469-335-7059
Mailing Address - Fax:
Practice Address - Street 1:3642 FAWN VALLEY DR APT 2058
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-5334
Practice Address - Country:US
Practice Address - Phone:469-335-7059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX825354163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse