Provider Demographics
NPI:1356042204
Name:ONWUOGU, IJEOMA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:IJEOMA
Middle Name:
Last Name:ONWUOGU
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:IJEOMA
Other - Middle Name:VICTORIA
Other - Last Name:ONWUOGU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP
Mailing Address - Street 1:6 PAUL AVE
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2621
Mailing Address - Country:US
Mailing Address - Phone:617-538-8253
Mailing Address - Fax:
Practice Address - Street 1:484 LOWELL ST STE 2B-1
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7974
Practice Address - Country:US
Practice Address - Phone:781-346-7248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2297756363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health