Provider Demographics
NPI:1801000310
Name:NWIGWE, OGBONNAYA (RN)
Entity Type:Individual
Prefix:
First Name:OGBONNAYA
Middle Name:
Last Name:NWIGWE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3854 W BROADWAY AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2253
Mailing Address - Country:US
Mailing Address - Phone:763-535-9649
Mailing Address - Fax:
Practice Address - Street 1:2147 UNIVERSITY AVE W STE 214
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1327
Practice Address - Country:US
Practice Address - Phone:651-647-9717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 155578-7163WH0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WH0200XNursing Service ProvidersRegistered NurseHome Health
Not Answered163W00000XNursing Service ProvidersRegistered Nurse