Provider Demographics
NPI:1558909994
Name:OBI, AUGUSTINA (NP)
Entity Type:Individual
Prefix:
First Name:AUGUSTINA
Middle Name:
Last Name:OBI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8874 TRILLIUM DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9647
Mailing Address - Country:US
Mailing Address - Phone:734-277-3984
Mailing Address - Fax:
Practice Address - Street 1:4201 SAINT ANTOINE ST STE 5C
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-577-5030
Practice Address - Fax:313-745-4707
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704267703363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner