Provider Demographics
NPI:1598242109
Name:OLIGBO, EARNESTINE
Entity Type:Individual
Prefix:MS
First Name:EARNESTINE
Middle Name:
Last Name:OLIGBO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:EARNESTINE
Other - Middle Name:
Other - Last Name:MCHUNU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1010 REMINGTON PLZ
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-8640
Mailing Address - Country:US
Mailing Address - Phone:816-318-4430
Mailing Address - Fax:
Practice Address - Street 1:1010 REMINGTON PLZ
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-8640
Practice Address - Country:US
Practice Address - Phone:816-318-4430
Practice Address - Fax:816-322-5445
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO058380164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse