Provider Demographics
NPI:1851122766
Name:UGOH, NGOZI THERESA
Entity type:Individual
Prefix:
First Name:NGOZI
Middle Name:THERESA
Last Name:UGOH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:THERESA
Other - Last Name:UGOH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:822 KLEMM AVE
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08030-1627
Mailing Address - Country:US
Mailing Address - Phone:856-282-5566
Mailing Address - Fax:
Practice Address - Street 1:822 KLEMM AVE
Practice Address - Street 2:
Practice Address - City:GLOUCESTER CITY
Practice Address - State:NJ
Practice Address - Zip Code:08030-1627
Practice Address - Country:US
Practice Address - Phone:856-282-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15110600363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health