Provider Demographics
NPI:1275267130
Name:OBIEBI, SANDRA E
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:E
Last Name:OBIEBI
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 1:27 BEHLMANN FARMS CT
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-2859
Mailing Address - Country:US
Mailing Address - Phone:314-358-3578
Mailing Address - Fax:
Practice Address - Street 1:27 BEHLMANN FARMS CT
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-2859
Practice Address - Country:US
Practice Address - Phone:131-435-8357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023032938363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health