Provider Demographics
NPI:1841554458
Name:OGBANGA, DATA (FNP-BC)
Entity type:Individual
Prefix:
First Name:DATA
Middle Name:
Last Name:OGBANGA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 N MAJOR DR
Mailing Address - Street 2:APT. 1002
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77713-9611
Mailing Address - Country:US
Mailing Address - Phone:409-554-0094
Mailing Address - Fax:
Practice Address - Street 1:10777 KUYKENDAHL RD
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-2772
Practice Address - Country:US
Practice Address - Phone:409-212-9988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX800900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily