Provider Demographics
NPI:1871280180
Name:OGBALU, IIFEOMA P
Entity type:Individual
Prefix:
First Name:IIFEOMA
Middle Name:P
Last Name:OGBALU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:
Other - Last Name:JENTZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:360 W BOYLSTON ST RM 216
Mailing Address - Street 2:
Mailing Address - City:WEST BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01583-2368
Mailing Address - Country:US
Mailing Address - Phone:774-420-8732
Mailing Address - Fax:
Practice Address - Street 1:360 W BOYLSTON ST RM 216
Practice Address - Street 2:
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-2368
Practice Address - Country:US
Practice Address - Phone:774-420-8732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker