Provider Demographics
NPI:1013413616
Name:IYOHA, OBEHI
Entity Type:Individual
Prefix:
First Name:OBEHI
Middle Name:
Last Name:IYOHA
Suffix:
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 1:2200 BENT CREEK CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-1988
Mailing Address - Country:US
Mailing Address - Phone:214-809-0866
Mailing Address - Fax:
Practice Address - Street 1:2200
Practice Address - Street 2:BENT CREEK COURT
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7606
Practice Address - Country:US
Practice Address - Phone:214-809-0866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX308645164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse