Provider Demographics
NPI:1922640572
Name:YOGBOH, THERESA AUDREY (MSN,CRNP,FNP-C)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:AUDREY
Last Name:YOGBOH
Suffix:
Gender:F
Credentials:MSN,CRNP,FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7924 OAK HILL DR
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19012-1708
Mailing Address - Country:US
Mailing Address - Phone:484-802-0790
Mailing Address - Fax:
Practice Address - Street 1:8001 STATE RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-2908
Practice Address - Country:US
Practice Address - Phone:215-335-4869
Practice Address - Fax:215-335-1205
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020103207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine