Provider Demographics
NPI:1194036053
Name:OBIRI, OMASILEM (CRNP)
Entity Type:Individual
Prefix:
First Name:OMASILEM
Middle Name:
Last Name:OBIRI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:OMASILEM
Other - Middle Name:
Other - Last Name:ELEKWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:680 BLAIR MILL RD
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-2223
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3301 TRINDLE RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4413
Practice Address - Country:US
Practice Address - Phone:717-412-7859
Practice Address - Fax:717-965-3214
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN613239163W00000X
PASP016941363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse