Provider Demographics
NPI:1700369493
Name:MOGAKA, SUSAN OBENCHA JR
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:OBENCHA
Last Name:MOGAKA
Suffix:JR
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8018 BLUE DUCK TRL
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4494
Mailing Address - Country:US
Mailing Address - Phone:720-589-0371
Mailing Address - Fax:
Practice Address - Street 1:8018 BLUE DUCK TRL
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-4494
Practice Address - Country:US
Practice Address - Phone:720-589-0371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX336921164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse