MEDICARE: MS. MATILDA N OBENG MSN, APRN

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
1	163W00000X	Registered Nurse	RN.386555	OH
2	363LP2300X	Primary Care Nurse Practitioner	0030951	OH

General Provider Information

NPI Number	:	1699074252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MATILDA N OBENG MSN, APRN

Provider Business Mailing Address
First Line	:	5410 ASTER PARK DR
Second Line	:	APT 701
City	:	WEST CHESTER
State	:	OH
Zip	:	45011-9481
Country	:	US
Telephone Number	:	513-275-8083
Fax Number	:

Provider Business Practice Location Address
First Line	:	5410 ASTER PARK DR
Second Line	:	APT 701
City	:	WEST CHESTER
State	:	OH
Zip	:	45011-9481
Country	:	US
Telephone Number	:	513-275-8083
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2011
Last Update Date	:	03/11/2022

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