Healthcare Provider Details

I. General information

NPI: 1497210173
Provider Name (Legal Business Name): OBIANUJU JULIET OFFOR CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 LOUISIANA BLVD NE STE 401
ALBUQUERQUE NM
87110-7020
US

IV. Provider business mailing address

2230 E 26TH WAY
YUMA AZ
85365-3260
US

V. Phone/Fax

Practice location:
  • Phone: 505-260-4306
  • Fax:
Mailing address:
  • Phone: 661-992-7554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number55123
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: