Provider Demographics
NPI:1801972724
Name:NTUKOGU, OBIAMAKA REGINA (RN)
Entity type:Individual
Prefix:MRS
First Name:OBIAMAKA
Middle Name:REGINA
Last Name:NTUKOGU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MIDLAND ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1768
Mailing Address - Country:US
Mailing Address - Phone:508-243-7181
Mailing Address - Fax:
Practice Address - Street 1:1140 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02125-3305
Practice Address - Country:US
Practice Address - Phone:617-288-0970
Practice Address - Fax:617-474-0757
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212688163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse