Provider Demographics
NPI:1265994818
Name:NWOSU, OGOCHUKWU RAPHAELA (DNP, FNP-BC,PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:OGOCHUKWU
Middle Name:RAPHAELA
Last Name:NWOSU
Suffix:
Gender:F
Credentials:DNP, FNP-BC,PMHNP-BC
Other - Prefix:
Other - First Name:OGOCHUKWU
Other - Middle Name:RAPHAELA
Other - Last Name:ENENDU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5055 BUSINESS CENTER DR STE 108
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1668
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 ALFRED NOBEL DR STE A
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1834
Practice Address - Country:US
Practice Address - Phone:510-984-1103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011786363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health