Provider Demographics
NPI:1942454780
Name:OGU, THERESA
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:OGU
Suffix:
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 1:1045 N SAINT LUCAS ST
Mailing Address - Street 2:APT C
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-3757
Mailing Address - Country:US
Mailing Address - Phone:484-332-0546
Mailing Address - Fax:
Practice Address - Street 1:1045 N SAINT LUCAS ST
Practice Address - Street 2:APT C
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-3757
Practice Address - Country:US
Practice Address - Phone:484-332-0546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285802164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse