Provider Demographics
NPI:1053887497
Name:OSIGWE-ADIELE, OGECHUKWU
Entity type:Individual
Prefix:
First Name:OGECHUKWU
Middle Name:
Last Name:OSIGWE-ADIELE
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 1:19 MILL RUN DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-1169
Mailing Address - Country:US
Mailing Address - Phone:158-550-0892
Mailing Address - Fax:
Practice Address - Street 1:19 MILL RUN DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-1169
Practice Address - Country:US
Practice Address - Phone:585-500-8929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY758713163W00000X
NY404988363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse