Provider Demographics
NPI:1598428682
Name:OBIRI-BOATENG, MAAME S (PMHNP)
Entity Type:Individual
Prefix:
First Name:MAAME S
Middle Name:
Last Name:OBIRI-BOATENG
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 FIRST VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-3634
Mailing Address - Country:US
Mailing Address - Phone:210-685-0360
Mailing Address - Fax:
Practice Address - Street 1:17715 OVERLOOK LOOP APT 8101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-1786
Practice Address - Country:US
Practice Address - Phone:213-731-7004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-15
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX869655163WH0200X
TX1058248363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty