Provider Demographics
NPI:1184416471
Name:OMASAN UNOKESAN, NJIDEKA PATRICIA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:NJIDEKA
Middle Name:PATRICIA
Last Name:OMASAN UNOKESAN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:NJIDEKA
Other - Middle Name:PATRICIA
Other - Last Name:OBIJIAKU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:539 SOUTHBRIDGE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-3700
Mailing Address - Country:US
Mailing Address - Phone:774-502-3400
Mailing Address - Fax:774-502-3400
Practice Address - Street 1:300 FRIBERG PKWY
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-3900
Practice Address - Country:US
Practice Address - Phone:508-329-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2373333163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent