Provider Demographics
NPI:1609205533
Name:OJIBWAY, JOSEPH C (FNP)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:C
Last Name:OJIBWAY
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7572 S SHEPHERD RD
Mailing Address - Street 2:
Mailing Address - City:SHEPHERD
Mailing Address - State:MI
Mailing Address - Zip Code:48883-9034
Mailing Address - Country:US
Mailing Address - Phone:802-299-9549
Mailing Address - Fax:
Practice Address - Street 1:7572 S SHEPHERD RD
Practice Address - Street 2:
Practice Address - City:SHEPHERD
Practice Address - State:MI
Practice Address - Zip Code:48883-9034
Practice Address - Country:US
Practice Address - Phone:802-299-9549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18090363LF0000X
MI4704370738363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1533407Medicaid
TN10350I7959Medicare PIN