=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124844303
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYNTHIA OBIAGELI EJOH APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2024
-----------------------------------------------------
Last Update Date | 12/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1790 MERCER PKWY APT 8304
-----------------------------------------------------
City | FARMERS BRANCH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75234-1454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-763-6415
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1790 MERCER PKWY APT 8304
-----------------------------------------------------
City | FARMERS BRANCH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75234-1454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-763-6415
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1180345
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------