Provider Demographics
NPI:1699721571
Name:BWOGI, ELIZABETH NAMALA (CNM)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:NAMALA
Last Name:BWOGI
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 MAIN ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4342
Mailing Address - Country:US
Mailing Address - Phone:508-559-1567
Mailing Address - Fax:508-559-5073
Practice Address - Street 1:157 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4012
Practice Address - Country:US
Practice Address - Phone:508-559-6699
Practice Address - Fax:508-583-4649
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230164176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
0037724OtherNEIGHBORHOOD HEALTH PLAN
93339OtherHEALTHY START
93339OtherCMSP
Q69527Medicare UPIN