Provider Demographics
NPI:1538311360
Name:OMOREGIE-EDEWI, PATRICIA NWAKAEGO (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:NWAKAEGO
Last Name:OMOREGIE-EDEWI
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 1:60 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-3835
Mailing Address - Country:US
Mailing Address - Phone:617-835-2659
Mailing Address - Fax:
Practice Address - Street 1:60 PINE AVE
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-3835
Practice Address - Country:US
Practice Address - Phone:617-835-2659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA266356163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse