Provider Demographics
NPI:1679715213
Name:OGBEBOR, IKPONMWOSA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:IKPONMWOSA
Middle Name:
Last Name:OGBEBOR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:857 HALESWORTH DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-1856
Mailing Address - Country:US
Mailing Address - Phone:513-761-2767
Mailing Address - Fax:
Practice Address - Street 1:857 HALESWORTH DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-1856
Practice Address - Country:US
Practice Address - Phone:513-761-2767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 134112 - IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse