Provider Demographics
NPI:1487925608
Name:OZIGBOH-LEE, CORDELIA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CORDELIA
Middle Name:
Last Name:OZIGBOH-LEE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 CHAPEL HILL DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-8625
Mailing Address - Country:US
Mailing Address - Phone:469-900-6489
Mailing Address - Fax:
Practice Address - Street 1:141 CHAPEL HILL DR
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-8625
Practice Address - Country:US
Practice Address - Phone:469-900-6489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016712363LP0808X
TXAP146047363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health