Provider Demographics
NPI:1942753876
Name:OGBONNA, FLORA
Entity Type:Individual
Prefix:
First Name:FLORA
Middle Name:
Last Name:OGBONNA
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 1:7515 BUCHANAN ST
Mailing Address - Street 2:APT. 131
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-2354
Mailing Address - Country:US
Mailing Address - Phone:240-938-5811
Mailing Address - Fax:
Practice Address - Street 1:7515 BUCHANAN ST
Practice Address - Street 2:APT. 131
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-2354
Practice Address - Country:US
Practice Address - Phone:240-938-5811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1008101164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCLPN1008101OtherDC. DEPT. HEALTH