Provider Demographics
NPI:1831684786
Name:OFOEGBU, HENRIETTA O (WHNP)
Entity type:Individual
Prefix:MRS
First Name:HENRIETTA
Middle Name:O
Last Name:OFOEGBU
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1318 W 140TH ST
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-2216
Mailing Address - Country:US
Mailing Address - Phone:310-713-0476
Mailing Address - Fax:
Practice Address - Street 1:1141 W REDONDO BEACH BLVD STE 402
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3582
Practice Address - Country:US
Practice Address - Phone:310-329-9492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-23
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95008621363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health