Provider Demographics
NPI:1417404526
Name:OBAROGHEDO, MAGDALENE
Entity Type:Individual
Prefix:
First Name:MAGDALENE
Middle Name:
Last Name:OBAROGHEDO
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 1:3306 RIVERWAY CT
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-4298
Mailing Address - Country:US
Mailing Address - Phone:972-489-8231
Mailing Address - Fax:972-222-2019
Practice Address - Street 1:3306 RIVERWAY CT
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-4298
Practice Address - Country:US
Practice Address - Phone:972-489-8231
Practice Address - Fax:972-222-2019
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX727640163WM1400X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No163WW0000XNursing Service ProvidersRegistered NurseWound Care