Healthcare Provider Details

I. General information

NPI: 1750891651
Provider Name (Legal Business Name): GEOFFREY OBIA FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MISSILE AVE
MINOT ND
58705-5003
US

IV. Provider business mailing address

10 MISSILE AVE
MINOT ND
58705-5003
US

V. Phone/Fax

Practice location:
  • Phone: 701-723-5633
  • Fax:
Mailing address:
  • Phone: 17-723-5633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number241208
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: