Provider Demographics
NPI:1053876698
Name:IFEANYI, OGONNA IFEOMA
Entity type:Individual
Prefix:MRS
First Name:OGONNA
Middle Name:IFEOMA
Last Name:IFEANYI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 MARTINIQUE AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044-0314
Mailing Address - Country:US
Mailing Address - Phone:702-979-8705
Mailing Address - Fax:
Practice Address - Street 1:2224 MARTINIQUE AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89044-0314
Practice Address - Country:US
Practice Address - Phone:702-979-8705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN57577364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health