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General NPI Number Information
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NPI Number | 1619757820
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Entity Type | Individual
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Provider Name | PAUL NYABERO OBINO PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 10/04/2023
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 5833 AMERICAN PKWY
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City | MADISON
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State | WI
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Zip | 53718-8325
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Country | US
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Telephone | 608-230-4632
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Fax |
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Provider Business Mailing Address
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Address Line | 202 SAINT ALBANS AVE
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City | MADISON
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State | WI
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Zip | 53714-2706
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Country | US
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Telephone | 612-423-3606
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 14675-33
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 252205
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License Number State | WI
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