Provider Demographics
NPI:1417684580
Name:ONOSODE, EKUEVUGBE PRISCILLIA (PMHNP)
Entity Type:Individual
Prefix:
First Name:EKUEVUGBE
Middle Name:PRISCILLIA
Last Name:ONOSODE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7011 CLAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2701
Mailing Address - Country:US
Mailing Address - Phone:248-924-5175
Mailing Address - Fax:
Practice Address - Street 1:7011 CLAMPTON CT
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2701
Practice Address - Country:US
Practice Address - Phone:248-924-5175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704319308163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health