Provider Demographics
NPI:1043079437
Name:OMBOGO, JULIETH (NP)
Entity type:Individual
Prefix:
First Name:JULIETH
Middle Name:
Last Name:OMBOGO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5434 S IDALIA WAY
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-4222
Mailing Address - Country:US
Mailing Address - Phone:651-500-8730
Mailing Address - Fax:
Practice Address - Street 1:5434 S IDALIA WAY
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-4222
Practice Address - Country:US
Practice Address - Phone:651-500-8730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0999595-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner