Provider Demographics
NPI:1881343366
Name:OGBODO, LINDA IFEOMA
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:IFEOMA
Last Name:OGBODO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10923 LOUIS DETRICK LN
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:MD
Mailing Address - Zip Code:21770-6024
Mailing Address - Country:US
Mailing Address - Phone:707-637-6859
Mailing Address - Fax:
Practice Address - Street 1:10923 LOUIS DETRICK LN
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:MD
Practice Address - Zip Code:21770-6024
Practice Address - Country:US
Practice Address - Phone:707-637-6859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR230584363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner