Provider Demographics
NPI:1215999040
Name:OGULA, VERONICA NGOZI (PMHNP/BC DNP)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:NGOZI
Last Name:OGULA
Suffix:
Gender:F
Credentials:PMHNP/BC DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 ASH STREET
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580
Mailing Address - Country:US
Mailing Address - Phone:516-812-7849
Mailing Address - Fax:
Practice Address - Street 1:115 S CORONA AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-6217
Practice Address - Country:US
Practice Address - Phone:917-825-8463
Practice Address - Fax:516-706-4908
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY400956363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400051105Medicare PIN