Provider Demographics
NPI:1194299842
Name:OGBONNA, PAMELA O (NP-C)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:O
Last Name:OGBONNA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 MURCHISON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4821
Mailing Address - Country:US
Mailing Address - Phone:915-544-4500
Mailing Address - Fax:
Practice Address - Street 1:1310 MURCHISON DR STE 100
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4821
Practice Address - Country:US
Practice Address - Phone:915-544-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139888363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily