Healthcare Provider Details

I. General information

NPI: 1598314049
Provider Name (Legal Business Name): OLUWABUNMI SARAH OBA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2019
Last Update Date: 09/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2669 SCENIC DR
ALAMOGORDO NM
88310-8700
US

IV. Provider business mailing address

2569 MAGNOLIA FAIR WAY
SPRING TX
77386-4274
US

V. Phone/Fax

Practice location:
  • Phone: 910-265-0271
  • Fax:
Mailing address:
  • Phone: 910-265-0271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number57158
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: