Provider Demographics
NPI:1558746651
Name:ADIBE, ADAOBI EZINNE, LAURA (MSN, FNP)
Entity Type:Individual
Prefix:MISS
First Name:ADAOBI
Middle Name:EZINNE, LAURA
Last Name:ADIBE
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:MISS
Other - First Name:ADAOBI
Other - Middle Name:EZINNE, LAURA
Other - Last Name:ONYEJIAKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, FNP
Mailing Address - Street 1:350 S 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-4915
Mailing Address - Country:US
Mailing Address - Phone:918-683-0753
Mailing Address - Fax:866-397-7556
Practice Address - Street 1:350 S 40TH ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401
Practice Address - Country:US
Practice Address - Phone:918-683-0753
Practice Address - Fax:866-397-7556
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK119620363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200627980AMedicaid
OK481013YMQ7Medicare PIN