Healthcare Provider Details

I. General information

NPI: 1740741933
Provider Name (Legal Business Name): JOAN OBOMESE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25110 GROGANS MILL RD
SPRING TX
77380-2248
US

IV. Provider business mailing address

25110 GROGANS MILL RD
SPRING TX
77380-2248
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2827
  • Fax:
Mailing address:
  • Phone: 866-389-2827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP139769
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: