Provider Demographics
NPI:1497367882
Name:OGOBUIRO, IKENNA CHIMAEZE (DNP, MBA, CRNA, APRN)
Entity type:Individual
Prefix:DR
First Name:IKENNA
Middle Name:CHIMAEZE
Last Name:OGOBUIRO
Suffix:
Gender:M
Credentials:DNP, MBA, CRNA, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1761 PLACITAS TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-1506
Mailing Address - Country:US
Mailing Address - Phone:214-874-8516
Mailing Address - Fax:
Practice Address - Street 1:1761 PLACITAS TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76131-1506
Practice Address - Country:US
Practice Address - Phone:214-874-8516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2024-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX845025163WC0200X
TX1166576367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine