MEDICARE: OBUNADIKE MBANUGO

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11000693	FL

General Provider Information

NPI Number	:	1700358777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OBUNADIKE MBANUGO

Provider Business Mailing Address
First Line	:	10855 SW 112TH AVE APT 118
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-3292
Country	:	US
Telephone Number	:	305-905-0233
Fax Number	:

Provider Business Practice Location Address
First Line	:	10855 SW 112TH AVE APT 118
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-3292
Country	:	US
Telephone Number	:	305-905-0233
Fax Number	:

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

Provider Enumeration Date	:	01/01/2019
Last Update Date	:	01/01/2019

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Directions to “ OBUNADIKE MBANUGO ” Practice Location

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