Provider Demographics
NPI:1912689308
Name:MGBEMENA, ONYEKACHI
Entity Type:Individual
Prefix:MRS
First Name:ONYEKACHI
Middle Name:
Last Name:MGBEMENA
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 1:146 QUIET CRES
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-5614
Mailing Address - Country:US
Mailing Address - Phone:609-481-7243
Mailing Address - Fax:
Practice Address - Street 1:338 COPPERFIELD DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-9260
Practice Address - Country:US
Practice Address - Phone:609-481-1712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP49543200164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty