Provider Demographics
NPI:1467116756
Name:OBARISIAGBON, ROSE OSAMUDIAMEN (RN)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:OSAMUDIAMEN
Last Name:OBARISIAGBON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:OSAMUDIAMEN
Other - Middle Name:ROSE
Other - Last Name:OBARISIAGBON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:44 COLLINS STREET TER
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-2206
Mailing Address - Country:US
Mailing Address - Phone:781-244-2291
Mailing Address - Fax:
Practice Address - Street 1:95 PLEASANT ST # 6
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1524
Practice Address - Country:US
Practice Address - Phone:781-581-4432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-24
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2339057163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult