Provider Demographics
NPI:1770177636
Name:OGBEIBOR, MONDAY (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MR
First Name:MONDAY
Middle Name:
Last Name:OGBEIBOR
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 PINE KNOLL CIR
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-7725
Mailing Address - Country:US
Mailing Address - Phone:269-419-1701
Mailing Address - Fax:
Practice Address - Street 1:110 N BURR BLVD
Practice Address - Street 2:
Practice Address - City:KEWANEE
Practice Address - State:IL
Practice Address - Zip Code:61443-8377
Practice Address - Country:US
Practice Address - Phone:309-852-0197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704321230363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health