Healthcare Provider Details

I. General information

NPI: 1851555833
Provider Name (Legal Business Name): RHOENA B OBAFIAL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W 4TH ST
ODESSA TX
79761-5001
US

IV. Provider business mailing address

PO BOX 2129
ODESSA TX
79760-2129
US

V. Phone/Fax

Practice location:
  • Phone: 432-640-4000
  • Fax: 432-640-2190
Mailing address:
  • Phone: 432-640-2408
  • Fax: 432-640-4606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024167901
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP131346
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: