Provider Demographics
NPI:1316257918
Name:OVBIEBO, JOY
Entity type:Individual
Prefix:MRS
First Name:JOY
Middle Name:
Last Name:OVBIEBO
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 1:512 45TH ST S
Mailing Address - Street 2:201
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1030
Mailing Address - Country:US
Mailing Address - Phone:701-235-3221
Mailing Address - Fax:
Practice Address - Street 1:512 45TH ST S
Practice Address - Street 2:APT 201
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1030
Practice Address - Country:US
Practice Address - Phone:701-235-3221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND33779376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide