Provider Demographics
NPI:1114784204
Name:OBIKULU, NDIDIAMAKA (APN)
Entity Type:Individual
Prefix:
First Name:NDIDIAMAKA
Middle Name:
Last Name:OBIKULU
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 RICHELIEU TER
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07106-2936
Mailing Address - Country:US
Mailing Address - Phone:973-870-1124
Mailing Address - Fax:
Practice Address - Street 1:252 RICHELIEU TER
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07106-2936
Practice Address - Country:US
Practice Address - Phone:973-870-1124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15019800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ15019800OtherNEW JERSEY BOARD OF NURSING