Basic Information
Provider Information
NPI: 1932792637
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: UNOBAGHA
FirstName: PATIENCE
MiddleName: OGOCHUKWU
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 3272
Address2:  
City: SAGINAW
State: MI
PostalCode: 486053272
CountryCode: US
TelephoneNumber: 9897971400
FaxNumber: 9897974077
Practice Location
Address1: 4677 TOWNE CENTRE RD STE 102
Address2:  
City: SAGINAW
State: MI
PostalCode: 486042847
CountryCode: US
TelephoneNumber: 9897900517
FaxNumber: 9897900216
Other Information
ProviderEnumerationDate: 02/15/2021
LastUpdateDate: 02/15/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/15/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X4704253799MIY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


Home