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NPI Code Detail

MEDICARE: MARYROSE OBIDIAKU NP

MEDICARE: MARYROSE OBIDIAKU NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAP131624TX

General Provider Information

NPI Number : 1043769284
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARYROSE OBIDIAKU NP
Provider Business Mailing Address
First Line : 5900 W PLEASANT RIDGE RD
Second Line :
City : ARLINGTON
State : TX
Zip : 76016-4427
Country : US
Telephone Number : 817-478-6041
Fax Number :
Provider Business Practice Location Address
First Line : 5900 W PLEASANT RIDGE RD
Second Line :
City : ARLINGTON
State : TX
Zip : 76016-4427
Country : US
Telephone Number : 817-478-6041
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2016
Last Update Date : 04/23/2026

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