Provider Demographics
NPI:1154562254
Name:OGWUEGBU, AUGUSTINA OGONNAYA
Entity type:Individual
Prefix:MRS
First Name:AUGUSTINA
Middle Name:OGONNAYA
Last Name:OGWUEGBU
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 1:1337 W 87TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-1823
Mailing Address - Country:US
Mailing Address - Phone:216-961-4501
Mailing Address - Fax:
Practice Address - Street 1:1337 W 87TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-1823
Practice Address - Country:US
Practice Address - Phone:216-961-4501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.114039164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse