Healthcare Provider Details

I. General information

NPI: 1801513692
Provider Name (Legal Business Name): FAITH WAWIRA OBONYO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 E BROAD ST
COLUMBUS OH
43213-2086
US

IV. Provider business mailing address

872 HILLTOP DR
BELLEFONTAINE OH
43311-2929
US

V. Phone/Fax

Practice location:
  • Phone: 614-404-1337
  • Fax:
Mailing address:
  • Phone: 937-215-9297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0033103
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: