Provider Demographics
NPI:1619758638
Name:OGU, IFEOMA O
Entity Type:Individual
Prefix:
First Name:IFEOMA
Middle Name:O
Last Name:OGU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:IFEOMA
Other - Middle Name:O
Other - Last Name:ECHEZONA OGU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:19449 112TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-2022
Mailing Address - Country:US
Mailing Address - Phone:347-238-8211
Mailing Address - Fax:
Practice Address - Street 1:2811 QUEENS PLZ N
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-4172
Practice Address - Country:US
Practice Address - Phone:718-391-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY791282163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool