Healthcare Provider Details

I. General information

NPI: 1770095788
Provider Name (Legal Business Name): JOSEPH ADEDEJI OBASANYA FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2017
Last Update Date: 10/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 MILLTOWN RD STE 2
WILMINGTON DE
19808-4047
US

IV. Provider business mailing address

27 SHADOW LN
BEAR DE
19701-3042
US

V. Phone/Fax

Practice location:
  • Phone: 302-463-8438
  • Fax:
Mailing address:
  • Phone: 302-983-4244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0001072
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: