Provider Demographics
NPI:1396985008
Name:ULOFOSHIO, OGBOUMA OKE
Entity type:Individual
Prefix:
First Name:OGBOUMA
Middle Name:OKE
Last Name:ULOFOSHIO
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:OGBOUMA
Other - Middle Name:OKE
Other - Last Name:ULOFOSHIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:240 E TUDOR RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-7244
Mailing Address - Country:US
Mailing Address - Phone:907-334-3050
Mailing Address - Fax:907-334-3058
Practice Address - Street 1:240 E TUDOR RD STE 100
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7244
Practice Address - Country:US
Practice Address - Phone:907-334-3050
Practice Address - Fax:907-334-3058
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK433132171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator