Healthcare Provider Details

I. General information

NPI: 1417404526
Provider Name (Legal Business Name): MAGDALENE OBAROGHEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3306 RIVERWAY CT
MESQUITE TX
75181-4298
US

IV. Provider business mailing address

3306 RIVERWAY CT
MESQUITE TX
75181-4298
US

V. Phone/Fax

Practice location:
  • Phone: 972-489-8231
  • Fax: 972-222-2019
Mailing address:
  • Phone: 972-489-8231
  • Fax: 972-222-2019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1072194
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License Number727640
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number727640
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: