Provider Demographics
NPI:1639996820
Name:ISIGUZO, PATIENCE OGECHI
Entity type:Individual
Prefix:
First Name:PATIENCE
Middle Name:OGECHI
Last Name:ISIGUZO
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 1:22202 IVANHOE LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-5113
Mailing Address - Country:US
Mailing Address - Phone:248-667-2182
Mailing Address - Fax:
Practice Address - Street 1:22202 IVANHOE LN
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-5113
Practice Address - Country:US
Practice Address - Phone:248-667-2182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704305719363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health