Healthcare Provider Details

I. General information

NPI: 1831749720
Provider Name (Legal Business Name): GABRIEL NWANNEBUIKE OBU PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 SE WASHINGTON ST
HILLSBORO OR
97123-4142
US

IV. Provider business mailing address

100 N HOWARD ST
SPOKANE WA
99201-0508
US

V. Phone/Fax

Practice location:
  • Phone: 503-755-6703
  • Fax: 503-755-6704
Mailing address:
  • Phone: 832-945-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1089146
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61378181
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number70473
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAC005902
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number296197
License Number StateAZ
# 6
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10019946
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: