Healthcare Provider Details

I. General information

NPI: 1639612898
Provider Name (Legal Business Name): CHINWE WINIFRED OBASI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHINWE WINIFRED OBASI APN

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 TREMONT AVENUE
EAST ORANGE NJ
07018
US

IV. Provider business mailing address

385 TREMONT AVE
EAST ORANGE NJ
07018-1023
US

V. Phone/Fax

Practice location:
  • Phone: 973-676-1000
  • Fax:
Mailing address:
  • Phone: 973-676-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00677500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: