Healthcare Provider Details

I. General information

NPI: 1538895016
Provider Name (Legal Business Name): EMELDA IWOBI PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 TEMI RD
BROCKTON MA
02302-3049
US

IV. Provider business mailing address

62 TEMI RD
BROCKTON MA
02302-3049
US

V. Phone/Fax

Practice location:
  • Phone: 857-251-2229
  • Fax:
Mailing address:
  • Phone: 857-251-2229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2294985
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: