Provider Demographics
NPI:1356833784
Name:OGIDAN-OBADINA, BOSEDE (APRN)
Entity Type:Individual
Prefix:
First Name:BOSEDE
Middle Name:
Last Name:OGIDAN-OBADINA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 S AVENUE A
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7170
Mailing Address - Country:US
Mailing Address - Phone:928-344-2000
Mailing Address - Fax:
Practice Address - Street 1:2451 S AVENUE A STE A104
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7189
Practice Address - Country:US
Practice Address - Phone:928-336-2165
Practice Address - Fax:928-336-2174
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-01
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137658363LG0600X
AZ224735363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology