Provider Demographics
NPI:1992685747
Name:OGBONNA, EMMANUEL C
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:C
Last Name:OGBONNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2590 ADRIENNE DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-4411
Mailing Address - Country:US
Mailing Address - Phone:734-929-7537
Mailing Address - Fax:
Practice Address - Street 1:2590 ADRIENNE DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-4411
Practice Address - Country:US
Practice Address - Phone:734-929-7537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704389970163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health