Provider Demographics
NPI:1740999887
Name:OGBUNWOBODO, AFAM EMMANUEL (RN)
Entity type:Individual
Prefix:
First Name:AFAM
Middle Name:EMMANUEL
Last Name:OGBUNWOBODO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8534 BLUE MAIDEN WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-3874
Mailing Address - Country:US
Mailing Address - Phone:510-776-6655
Mailing Address - Fax:
Practice Address - Street 1:8534 BLUE MAIDEN WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-3874
Practice Address - Country:US
Practice Address - Phone:510-776-6655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA802598163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice