Provider Demographics
NPI:1174117444
Name:ASIEGBU, IFEOMA MAUREEN (CNP, FNP, RN)
Entity type:Individual
Prefix:MRS
First Name:IFEOMA
Middle Name:MAUREEN
Last Name:ASIEGBU
Suffix:
Gender:F
Credentials:CNP, FNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 W BOYLSTON ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-3223
Mailing Address - Country:US
Mailing Address - Phone:508-373-2224
Mailing Address - Fax:
Practice Address - Street 1:390 W BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-3223
Practice Address - Country:US
Practice Address - Phone:508-373-2224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2306384363LF0000X
RIRN67571390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program