Healthcare Provider Details

I. General information

NPI: 1982373643
Provider Name (Legal Business Name): HANNAH OBANNI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 HILLTOP MALL RD STE 305
RICHMOND CA
94806-5274
US

IV. Provider business mailing address

6475 CHRISTIE AVE STE 300
EMERYVILLE CA
94608-2263
US

V. Phone/Fax

Practice location:
  • Phone: 510-222-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95018316
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: