Healthcare Provider Details

I. General information

NPI: 1902473911
Provider Name (Legal Business Name): SHARON OBUZOR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20755 GREENFIELD RD STE 100
SOUTHFIELD MI
48075-5400
US

IV. Provider business mailing address

33705 REGAL
FRASER MI
48026-1738
US

V. Phone/Fax

Practice location:
  • Phone: 248-557-0507
  • Fax:
Mailing address:
  • Phone: 586-843-6491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704298870
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: