Provider Demographics
NPI:1770315335
Name:OLUCHI GLORIA ONEBUNNE NP IN PSYCHIATRY PLLC
Entity type:Organization
Organization Name:OLUCHI GLORIA ONEBUNNE NP IN PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLUCHI
Authorized Official - Middle Name:GLORIA
Authorized Official - Last Name:ONEBUNNE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:516-350-8564
Mailing Address - Street 1:165 N VILLAGE AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3701
Mailing Address - Country:US
Mailing Address - Phone:516-350-8564
Mailing Address - Fax:516-874-2477
Practice Address - Street 1:165 N VILLAGE AVE STE 12
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3701
Practice Address - Country:US
Practice Address - Phone:516-350-8564
Practice Address - Fax:516-874-2477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty