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General NPI Number Information
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NPI Number | 1780230474
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Entity Type | Individual
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Provider Name | OTO-OBONG EDUOK
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Gender | Female
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Dates
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Enumeration Date | 08/17/2019
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 806 JEFFERSON TER
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City | NEW IBERIA
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State | LA
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Zip | 70560-5727
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Country | US
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Telephone | 337-365-4945
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Fax | 337-560-1359
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Provider Business Mailing Address
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Address Line | 107 RAVEN CLIFF LN
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City | BROUSSARD
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State | LA
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Zip | 70518-5340
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Country | US
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Telephone | 504-701-5607
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 203681
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License Number State | LA
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