Provider Demographics
NPI:1093429193
Name:OBUSEH, CHRISTABEL (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTABEL
Middle Name:
Last Name:OBUSEH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9637 FOREST LN APT 533
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-0921
Mailing Address - Country:US
Mailing Address - Phone:980-365-0844
Mailing Address - Fax:
Practice Address - Street 1:6300 SAMUELL BLVD STE 120
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-7100
Practice Address - Country:US
Practice Address - Phone:214-381-1910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant