Provider Demographics
NPI:1134446941
Name:NWOGU-GURDON, BLESSYN (NP)
Entity type:Individual
Prefix:MS
First Name:BLESSYN
Middle Name:
Last Name:NWOGU-GURDON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1689 E 55TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3905
Mailing Address - Country:US
Mailing Address - Phone:347-414-2740
Mailing Address - Fax:
Practice Address - Street 1:1021 E 57TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2507
Practice Address - Country:US
Practice Address - Phone:347-414-2740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY496676-1163WM0705X, 163WW0000X
NY310939363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WW0000XNursing Service ProvidersRegistered NurseWound Care