Provider Demographics
NPI:1699079327
Name:UZOH-ANIGBOGU, IFEOMA M (FNP, PMHNP, RN)
Entity type:Individual
Prefix:
First Name:IFEOMA
Middle Name:M
Last Name:UZOH-ANIGBOGU
Suffix:
Gender:F
Credentials:FNP, PMHNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8004 WILLOW BROOK CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-5014
Mailing Address - Country:US
Mailing Address - Phone:614-986-8485
Mailing Address - Fax:
Practice Address - Street 1:68 N HIGH ST BLDG A
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-7153
Practice Address - Country:US
Practice Address - Phone:614-668-2671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH358633163W00000X
OHAPRNCNP020914363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily