Healthcare Provider Details

I. General information

NPI: 1750160297
Provider Name (Legal Business Name): MRS. ABOSEDE ADEWUNMI OBANAWU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 THUNDER DOVE DR
MANSFIELD TX
76063-6550
US

IV. Provider business mailing address

1406 THUNDER DOVE DR
MANSFIELD TX
76063-6550
US

V. Phone/Fax

Practice location:
  • Phone: 817-372-4340
  • Fax:
Mailing address:
  • Phone: 817-372-4340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: