Healthcare Provider Details

I. General information

NPI: 1427307842
Provider Name (Legal Business Name): OBIAGERI E ONU CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 02/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 N CLASSEN BLVD STE 214
OKLAHOMA CITY OK
73106-6834
US

IV. Provider business mailing address

11440 WALTERS AVE
OKLAHOMA CITY OK
73162-1315
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-6710
  • Fax:
Mailing address:
  • Phone: 405-728-0525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0096537
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: