Healthcare Provider Details

I. General information

NPI: 1528402765
Provider Name (Legal Business Name): STELLAH KWAMBOKA OBIERO CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 SPRINGSIDE DR SUITE 205
AKRON OH
44333-4530
US

IV. Provider business mailing address

231 SPRINGSIDE DR SUITE 205
AKRON OH
44333-4530
US

V. Phone/Fax

Practice location:
  • Phone: 330-666-9544
  • Fax: 330-670-8569
Mailing address:
  • Phone: 330-666-9544
  • Fax: 330-670-8569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number14437-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95023659
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number277.002710
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: