Provider Demographics
NPI:1689070013
Name:EJIGIRI, OGECHI GRACE (PA-C)
Entity Type:Individual
Prefix:
First Name:OGECHI
Middle Name:GRACE
Last Name:EJIGIRI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 NEW ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-3654
Mailing Address - Country:US
Mailing Address - Phone:336-379-9708
Mailing Address - Fax:336-379-8714
Practice Address - Street 1:309 NEW ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-3654
Practice Address - Country:US
Practice Address - Phone:336-379-9708
Practice Address - Fax:336-379-8714
Is Sole Proprietor?:No
Enumeration Date:2014-11-12
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant