Provider Demographics
NPI:1598314049
Name:OBA, OLUWABUNMI SARAH (NP)
Entity Type:Individual
Prefix:
First Name:OLUWABUNMI
Middle Name:SARAH
Last Name:OBA
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 1:2569 MAGNOLIA FAIR WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-4274
Mailing Address - Country:US
Mailing Address - Phone:910-265-0271
Mailing Address - Fax:
Practice Address - Street 1:2669 SCENIC DR
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-8700
Practice Address - Country:US
Practice Address - Phone:910-265-0271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-07
Last Update Date:2019-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM57158363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care