Provider Demographics
NPI:1073895801
Name:OBIAKALUSI, PHEOBIAN CHIDUBEM (RN)
Entity Type:Individual
Prefix:MRS
First Name:PHEOBIAN
Middle Name:CHIDUBEM
Last Name:OBIAKALUSI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W RAHN RD STE 17
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2233
Mailing Address - Country:US
Mailing Address - Phone:937-434-4004
Mailing Address - Fax:937-732-5049
Practice Address - Street 1:30 W RAHN RD STE 17
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2233
Practice Address - Country:US
Practice Address - Phone:937-434-4004
Practice Address - Fax:937-732-5049
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH461365163WH0200X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0054033Medicaid