Provider Demographics
NPI:1700558608
Name:OBIDIGBO, ANITA NGOZI (DNP, AGPCNP)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:NGOZI
Last Name:OBIDIGBO
Suffix:
Gender:F
Credentials:DNP, AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EMILY WAY
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-3136
Mailing Address - Country:US
Mailing Address - Phone:860-716-5445
Mailing Address - Fax:
Practice Address - Street 1:1 EMILY WAY
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-3136
Practice Address - Country:US
Practice Address - Phone:860-716-5445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10209363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care