Healthcare Provider Details

I. General information

NPI: 1346043445
Provider Name (Legal Business Name): NOSAZENA OBASEKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/01/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 PLYMOUTH RD APT 9
ANN ARBOR MI
48105-1748
US

IV. Provider business mailing address

1550 PLYMOUTH RD APT 9
ANN ARBOR MI
48105-1748
US

V. Phone/Fax

Practice location:
  • Phone: 734-239-1579
  • Fax:
Mailing address:
  • Phone: 734-239-1579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6362009372
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6362009372
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: