Healthcare Provider Details

I. General information

NPI: 1790335529
Provider Name (Legal Business Name): CHRISTINA OLUWAKEMI OBADINA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8808 LIBERTY AVE
OZONE PARK NY
11417-1329
US

IV. Provider business mailing address

8808 LIBERTY AVE
OZONE PARK NY
11417-1329
US

V. Phone/Fax

Practice location:
  • Phone: 929-499-3419
  • Fax: 929-499-3419
Mailing address:
  • Phone: 929-499-3419
  • Fax: 929-499-3419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number749613
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: