Healthcare Provider Details

I. General information

NPI: 1275601528
Provider Name (Legal Business Name): CHRISTINE MARIE OBUSEK R.N., B.S.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 CENTRAL ST
WALTHAM MA
02453-5465
US

IV. Provider business mailing address

43 GOLDEN BALL RD
WESTON MA
02493-1507
US

V. Phone/Fax

Practice location:
  • Phone: 781-891-0556
  • Fax:
Mailing address:
  • Phone: 781-894-6229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN 206225
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: