Healthcare Provider Details

I. General information

NPI: 1972398329
Provider Name (Legal Business Name): STEPHEN OBONYO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SW 10TH AVE
TOPEKA KS
66604-1353
US

IV. Provider business mailing address

1330 N RIDGE PKWY APT E
OLATHE KS
66061-7029
US

V. Phone/Fax

Practice location:
  • Phone: 785-354-6000
  • Fax:
Mailing address:
  • Phone: 913-475-5037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number155392
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: