Provider Demographics
NPI:1992493837
Name:AIGBOKHAODE, ONOSIOMUZANA NERISA
Entity type:Individual
Prefix:
First Name:ONOSIOMUZANA
Middle Name:NERISA
Last Name:AIGBOKHAODE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 KESLER CT
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-1889
Mailing Address - Country:US
Mailing Address - Phone:470-456-1155
Mailing Address - Fax:
Practice Address - Street 1:705 JUNIPER ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1307
Practice Address - Country:US
Practice Address - Phone:717-353-0234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9625197163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse