Provider Demographics
NPI:1639612898
Name:OBASI, CHINWE WINIFRED (APN)
Entity Type:Individual
Prefix:MRS
First Name:CHINWE
Middle Name:WINIFRED
Last Name:OBASI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:CHINWE
Other - Middle Name:WINIFRED
Other - Last Name:OBASI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:385 TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1023
Mailing Address - Country:US
Mailing Address - Phone:973-676-1000
Mailing Address - Fax:
Practice Address - Street 1:385 TREMONT AVENUE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018
Practice Address - Country:US
Practice Address - Phone:973-676-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00677500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily