Provider Demographics
NPI:1053147496
Name:OGUGUO, CONSTANCE A (RN)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:A
Last Name:OGUGUO
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 1:1453 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1453 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2403
Practice Address - Country:US
Practice Address - Phone:973-968-0551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO10705800163WG0600X, 163WM0705X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical