Healthcare Provider Details

I. General information

NPI: 1609243914
Provider Name (Legal Business Name): LISA OBENG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

997 MILLBURY ST UNIT 4
WORCESTER MA
01607-2105
US

IV. Provider business mailing address

132 COUNTRY CLUB BLVD APT 615
WORCESTER MA
01605-1561
US

V. Phone/Fax

Practice location:
  • Phone: 508-335-0499
  • Fax:
Mailing address:
  • Phone: 508-335-0499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN2274454
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: