Provider Demographics
NPI:1063884062
Name:ESEGINE, ONORIODE (LPN)
Entity type:Individual
Prefix:
First Name:ONORIODE
Middle Name:
Last Name:ESEGINE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 DECATUR ST
Mailing Address - Street 2:APT. 2F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-1734
Mailing Address - Country:US
Mailing Address - Phone:917-476-2193
Mailing Address - Fax:
Practice Address - Street 1:206 DECATUR ST
Practice Address - Street 2:APT. 2F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-1734
Practice Address - Country:US
Practice Address - Phone:917-476-2193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY323923-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse