Healthcare Provider Details

I. General information

NPI: 1043962863
Provider Name (Legal Business Name): ALEXIS OBOH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2022
Last Update Date: 01/23/2022
Certification Date: 01/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8450 N SHERMAN CIR APT E-202
MIRAMAR FL
33025-5110
US

IV. Provider business mailing address

8450 N SHERMAN CIR APT E-202
MIRAMAR FL
33025-5110
US

V. Phone/Fax

Practice location:
  • Phone: 786-617-2147
  • Fax:
Mailing address:
  • Phone: 786-617-2147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number9477647
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: