Provider Demographics
NPI:1497210173
Name:OFFOR, OBIANUJU JULIET (CRNA)
Entity Type:Individual
Prefix:
First Name:OBIANUJU
Middle Name:JULIET
Last Name:OFFOR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 E 26TH WAY
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-3260
Mailing Address - Country:US
Mailing Address - Phone:661-992-7554
Mailing Address - Fax:
Practice Address - Street 1:1720 LOUISIANA BLVD NE STE 401
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7020
Practice Address - Country:US
Practice Address - Phone:505-260-4306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM55123367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered