Provider Demographics
NPI:1003238239
Name:OBIORA, ELIZABETH OBIAMAKA I
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:OBIAMAKA
Last Name:OBIORA
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 E NEW YORK AVE
Mailing Address - Street 2:4-F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225
Mailing Address - Country:US
Mailing Address - Phone:347-455-7507
Mailing Address - Fax:
Practice Address - Street 1:140 E NEW YORK AVE
Practice Address - Street 2:4-F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225
Practice Address - Country:US
Practice Address - Phone:347-455-7507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317313164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse